Brief updates on epidemiology, variants, vaccines and more…
by Dr. Debbie-Ann Shirley, Division Head of Pediatric Infectious Disease
The pandemic and children. Over 4.03 million children have tested positive for COVID-19 in the United States and 4,018 patients have been diagnosed with the severe multisystem inflammatory syndrome in children following COVID-19 infection (MIS-C), including 75 children from Virginia. Somewhat reassuring longer term outcome data on MIS-C is starting to trickle in. For example, after six months, most major organ-specific sequelae involving the heart, gastrointestinal, renal and hematologic systems resolved in a retrospective study of 46 children though fatigue and emotional lability persisted longer, reminding us to also be aware of the long-term effects following COVID-19 infection.
Variants of concern. The World Health Organization has recently begun to refer to variants by Greek letters rather than country of first detection. The alpha (B.1.1.7) variant remains the predominant variant in the US, currently predicted to account for about 60% of viral lineages, but the incidence of the highly transmissible delta variant (B.1.617) first detected in India is rapidly spreading throughout the entire country. The delta variant has already been detected in nearly 100 countries around the world, including taking over as the predominant strain in the United Kingdom. Fortunately, the COVID-19 vaccines provide effective protection against symptomatic disease and hospitalization caused by the delta variant, reinforcing the importance of being fully vaccinated.
COVID-19 vaccines and children. Following FDA expanded emergency use authorization of the Pfizer-BioNTech COVID-19 mRNA vaccine to adolescents ages 12 to 15 years on May 10th, post-authorization surveillance has identified rare reports of brief myocarditis and pericarditis that have emerged, more commonly in male adolescents and young adults within a week of the second dose of a COVID mRNA vaccine. The advisory group to the CDC on immunization practices meet on June 23rd to discuss the 1,226 cases of myocarditis reported to the Vaccine Adverse Event Reporting System (VAERS) among 300 million doses of mRNA COVID vaccine administered nationwide. The advisory group determined the benefits of vaccination continue to outweigh the rare risks of myocarditis and pericarditis. The CDC, American Academy of Pediatrics, American Heart Association and several other health leaders endorsed vaccination in those 12 years and older in a statement released following the meeting. Any patient with chest pain shortly after receiving a COVID vaccine should be evaluated with troponin level and ECG. Clinician guidance on evaluation and management of myocarditis is available and all cases should be reported to VAERS. The FDA has updated their provider and patient fact sheets to include risk of myocarditis. Draft guidance from the CDC on deferring the second dose in those who develop myocarditis or pericarditis following the first dose is being finalized.
In other vaccine-related updates, the UVA lab now offers both a quantitative spike protein IgG antibody and/or a qualitative IgG nucleocapsid IgG antibody tests to help understand the presence of past infection or the response to vaccine. Without a yet established correlate of protection however, the FDA advises against routine post-vaccination titers. The practice of giving a third dose of COVID-19 vaccine is outside of the current emergency use authorization, and there is limited safety and efficacy date regarding this approach. Studies on how best to address low antibody responses in immunosuppressed patients are ongoing, so additional guidance is anticipated soon. In the meantime, masking, distancing, and hand hygiene can help to provide additional layers of protection to vaccinated immunosuppressed patients.
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