With the recent approval of the COVID-19 vaccine for use in young children, we interview pediatric infectious diseases expert, Dr. Deborah Lehman. Dr. Lehman is a professor of pediatrics at the David Geffen School of Medicine at UCLA. She received her undergraduate degree from Stanford and MD from UCLA School of Medicine. She completed her pediatric residency at Children’s Hospital of Los Angeles and pediatric infectious diseases training at UCSF.
(Please note, this interview was conducted in early December 2021. For the most up to date information and resources about COVID-19, please visit the UCLA Health COVID-19 information page . If you are interested in learning more about the vaccine, please visit the UCLA Health COVID-19 Vaccine Information Hub)
Matt: In late October 2021, the FDA authorized Pfizer’s COVID-19 vaccine for emergency use in children 5-11 years old. Can you share your thoughts on this announcement?
Dr. Lehman: The FDA’s decision and the recommendation from CDC’s committee on immunization practices that followed for use of this vaccine for younger children was good news for so many – those of us who treat, live with, and interact with children! We recognize that we will not be able to get this pandemic under control without fully protecting the entire population, and that includes these younger school-aged children.
Matt: What can we expect moving forward with vaccination approvals for children?
Dr. Lehman: Vaccines are now approved for children down to 5 years of age. The next step in vaccine approval will be for children as young as 6 months of age. Trials are currently ongoing to test vaccine safety and efficacy, as well as appropriate vaccine dose in younger children and infants, and we should expect some results early next year. Until then, the most important thing that parents can do is to make sure the rest of the household and the child’s contacts are vaccinated (parents, grandparents and older siblings). It is also important for pregnant and nursing women to receive COVID-19 vaccine as this has been shown to not only reduce stillbirth and other pregnancy complications, but also provides protection to the fetus before they are born, which then lingers for the first few months after birth, protecting the infant from COVID-19. There is also really exciting research demonstrating COVID-19 antibodies in breastmilk of vaccinated women, antibodies they can pass on to their nursing infants!
Matt: There appear to be age-related differences in both the infection rates and severity of COVID-19 in children. How does this data relate to youth vaccinations? Why should children still get vaccinated against COVID-19?
Dr. Lehman: At the start of the pandemic, it appeared that children were less frequently infected with SARS-CoV-2, and when they did become infected, they were less likely to develop severe disease and require hospitalization. We now are seeing quite a shift as more and more adults are vaccinated, children account for up to a quarter of new cases, and in areas of the country where the virus is surging, children are filling up hospital beds. Children with COVID-19, even those with asymptomatic or very mild cases, can also develop a life-threatening condition known as MIS-C, where the child’s organs become inflamed and children do indeed become critically ill. As of last month, over 2,000 children have been diagnosed with this condition, which can have long lasting effects on the heart and other organs. We also know now that children can develop long COVID even after recovery from mild disease. Children should get vaccinated with the COVID-19 vaccine to protect themselves, their family, and their community. Almost 7 million children have been infected with SARS-CoV-2, the virus that causes COVID-19, and that is almost certainly an undercount. Of those millions of children, thousands have required hospitalization and over 700 have died. In addition, as with other respiratory viruses that circulate every year, children are frequently the first case in a family, and can transmit infection to others, including older adults and those most at risk for serious outcomes.
Matt: Some parents may be hesitant to vaccinate their children. What information can you share to help address their concerns?
Dr. Lehman: I would assure parents that the COVID-19 vaccines among the most widely used and studied vaccines we have. The sheer number of children so far who have been vaccinated against COVID should also be reassuring to parents. As of last week, 3.6 million US children ages 5-11 have received at least one dose of COVID-19 vaccine, representing 13% of 5–11-year-olds. 15 million US children and adolescents ages 12- 17 have received at least one dose of COVID-19 vaccine, representing 60% of 12–17-year-olds. Parents may think that if their child gets COVID-19 their case may be mild, so they do not need to vaccinate them, however, with the rising number of cases in children (over 2 million cases in children aged 5-11 years old have led to over 8,000 hospitalizations, and unfortunately, over 100 deaths). These numbers are greater than what we see each year with influenza. You cannot predict whether your child will have a mild COVID-19 infection or one of these more tragic outcomes. Vaccination is what you can do now to significantly reduce the risk of your child being hospitalized or dying from COVID-19.
Matt: Do you have recommendations to share for how parents can help prepare their children for a vaccination appointment?
Dr. Lehman: The good news is that children do very well with doctor visits and with vaccination. Offices that care for children are typically welcoming and friendly. Children get their first vaccine at birth (Hepatitis B Vaccine) and then starting at 2 months of age receive vaccinations regularly at their well child visits. Sometimes we as parents are more anxious about our children receiving shots, but it is over quickly and once it is finished it is quickly forgotten. Parents can do a lot by reinforcing that this is something they are doing to keep the child and the family healthy. With the opening of family vaccination clinics, parents and children will have the opportunity to get their vaccines together, making it a family event.
Matt: Do you have any other thoughts to share about COVID-19 vaccinations and children?
Dr. Lehman: We recognize that it is difficult for some parents to do something actively to their child to prevent something from happening when they aren’t sure of the real risks. I would urge them to consider the vaccine like a seat belt or car seat or bike helmet. It is something you do to prevent an awful and unpredictable outcome. Something that you cannot control. The time to put on that seatbelt or put your child in their car seat is before you get on the road, and we are all on the road now! This is especially important now as we are facing a new variant, Omicron. This variant has many more mutations than previous variants, so we are closely watching how it will impact communities. What we see thus far is that it appears to be highly contagious, and that those who are unvaccinated will be at the greatest risk for infection. So the advice continues to be, protect your children, your family and your community by getting everyone who can be vaccinated (those 5 years of age and older) vaccinated!