COVID-19 Children’s Corner: September

August 31, 2021 by

Brief updates on epidemiology, variants, vaccines and more…

by Dr. Cassie Kirschner, MD, Pediatric Resident UVA and Dr. Debbie-Ann Shirley, MD

The pandemic and children. Nearly 4.6 million child cases of COVID-19 have been reported in the United States to date, with at least 454 deaths. The number of new cases in children has quintupled since early July, with an astounding 204,000 new child COVID-19 cases reported in the week of August 26th. Cases have similarly rapidly escalated locally and in Virginia. Children are still less likely to have severe disease when compared to adults, but the number of pediatric ED and hospital admissions is rising– though it is not yet clear if this if from high transmissibility of the current variant, or if the variant also causes more severe disease. This surge also comes amid the spike in RSV cases. Last month, the AAP released interim guidance for palivizumab prophylaxis and supports use in patients who would be candidates per current eligibility recommendations, which is now available at UVA.

Outpatient management of children with COVID-19 remains supportive. Pediatricians should avoid prescribing the antihelminthic agent ivermectin to children to treat COVID-19, as there is insufficient evidence to recommend use, and serious toxicity with overdose in children such as neurolgic effects, hypotension and gastrointestinal distress is being reported. Pediatricians should also be on the lookout for new MIS-C cases, which tend to lag the rises in COVID cases by a few weeks, so may be starting to surface soon. To date over 4,404 patients have been diagnosed with the severe multisystem inflammatory syndrome in children following COVID-19 infection (MIS-C), including 81 children from Virginia. Reassuringly, medium term outcomes appear overall reassuring, with rapid recovery for most discharged children.

Variants of concern. The delta (B.1.617) variant, which has quickly emerged to become the predominant variant in the US, currently accounts for almost all cases with estimates to be 98.8% of viral lineages. New data shows that vaccinated people can become infected and spread the virus, even when asymptomatic. The CDC has hence added the recommendation for fully vaccinated people to wear a mask in public indoor settings in areas of substantial or high transmission, and if they come into close contact with someone with suspected or confirmed COVID-19 to be tested 3-5 days after exposure. Despite these concerning developments with the delta variant, vaccines remain highly effective at preventing severe disease, saving lives. Urgently working to increase vaccination coverage should remain a high priority for us all to reduce transmission as well as reduce the risk of more emerging variants.

COVID-19 vaccines and children. Last month the FDA amended the emergency use authorization for both the Pfizer-BioNTech and Moderna COVID-19 vaccines to allow administration of an additional dose in certain immunocompromised individuals, specifically, solid organ transplant recipients or those who are diagnosed with conditions that are considered to have an equivalent level of immunocompromise, to provide additional protection.

Shortly after this decision, the FDA also approved the Pfizer-BioNTech COVID-19 vaccine, Comirnaty, for patients aged 16 years and older. All UVA team members are now required to be vaccinated by November 1st.  The package insert will include a warning about the rare risk of myocarditis, especially within the week after the second dose, which seems most common in males 12-17 years of age. The overall risk of myocarditis is about 16 per million second doses, fortunately with quick recovery reported for most.

Looking ahead, adults may be eligible for booster doses soon. If authorized, booster doses would be given starting 8 months after completion of the primary series and so it is anticipated that booster doses would initially roll out to health care personnel, residents of long-term care facilities and older adults. We are still awaiting further guidance regarding booster doses from the FDA and CDC though. Pfizer has stated they will have booster data to share in late September or October.

COVID-19 vaccine clinical trials for those 11 years and younger are also still underway and we expect to see clinical data on the 5-11 year age group this fall. As of yet, there has been no safety data released for these younger age groups and pediatricians should avoid administering COVID-19 vaccines off-label, which could introduce liability to providers and jeopardize the ability to administer COVID-19 vaccines under the CDC provider agreement. In the meantime, encourage everyone who is eligible to get vaccinated to help reduce the spread of the virus to younger children. About 11.2 million children under age 18 have received at least one dose of COVID-19 vaccine in the US, representing 55% of 16-17 year olds and 45% of 12-15 year olds, so there is still work to be done in eligible age groups.

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