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Dr. Yvonne Maldonado: COVID vaccines for children

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Vaccinations against COVID-19 are now available for children ages 5 and up.

On Thursday, November 11th, SciLine interviewed: Dr. Yvonne Maldonado, chief of the pediatric infectious diseases department at the Stanford University School of Medicine. See the footage and transcript from the interview below, or select ‘Contents’ on the left to skip to specific questions.

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YVONNE MALDONADO: My name is Yvonne Maldonado, and I’m the Taube Professor of Global Health and Infectious Diseases at Stanford University School of Medicine. I’m a pediatric infectious disease epidemiologist, and my area of research is vaccine epidemiology in children, primarily in global health settings.

Interview with SciLine

What do we know about the safety and effectiveness of the Pfizer/BioNTech COVID-19 vaccine for children ages 5 to 11?


YVONNE MALDONADO: Specifically in the 5- to 11-year-old age group, we have data from Pfizer because that’s the data that’s been published so far, and that is in over 4,000 children who were followed after two doses of a smaller dose than is given to adults and older children. So it’s one-third the dose of the dose given to people 12 and older. And these are two doses given 21 days apart. And these children were followed over several months to look for evidence of protection against COVID infection, symptomatic infection, as well as development of antibodies and as well, of course, for safety. What we found was that the safety and reactions to the vaccine were similar to those seen in older children and adults, so pain and redness at the side of injection for a few days. And then the most common other effects were low-grade fever, mild headache and mild fatigue, which lasted about one or two days at the most. The vaccine provided robust immune responses, antibodies, to the virus that were equivalent to those found in older children and adults. And probably most importantly, the number of cases of symptomatic COVID in the vaccine group was 90% less than that in the placebo recipients. So we know that this vaccine is 90%-plus effective in preventing symptomatic COVID infection in this age group.

What is your advice for parents regarding the decision to vaccinate kids against COVID-19?


YVONNE MALDONADO: Over half of the world’s population – over 3.5 billion people – have now been vaccinated with at least one dose of these vaccines, so we know a lot about their safety and their ability to protect us from infection. And in particular, the vaccines that have been used in the United States are extremely safe. They’re very effective. So the main thing I would urge parents to do is to think about the risks to their children, about getting COVID infections. And children going back to school and sports and being able to act like they did before the pandemic in terms of getting together socially with their friends and family members is really important for them and for their family. And the vaccine will add another layer of protection to keep them from getting sick.

But also, in this 5- to 11-year age group, we know that there are – have been over 8,000 hospitalizations in the U.S. and almost a hundred deaths in children from this particular disease. So the vaccine can also prevent hospitalizations and deaths in children 5 to 11. And because about half of children who have experienced serious disease have no underlying causes for them, we can’t really target children who would be at high risk for symptomatic, severe disease. So it’s really important to have children vaccinated. The American Academy of Pediatrics and every other major national society has supported the use of vaccination, including in children 5 to 11. And finally, people are going to have questions, and that’s really important and natural to have. And so we would like families to talk to their pediatric caregivers, to ask them questions. Pediatricians are fully behind these vaccines and are eager to answer questions for families who have them about giving these vaccines because we know that they will protect our children.

Can vaccinated kids and families safely change masking and social distancing behaviors?


YVONNE MALDONADO: So it really depends on what part of the country you live in and what county or state guidelines say. So there are different practices across the country. So really can’t say too much about that, but we do know, for example, that there is very, very strong evidence that masking and distancing alone really do protect children and schoolmates and family members and teachers from getting infected. So we know that those are layers of protection. But with vaccines, you can add an additional layer of protection. Now, unfortunately, we do know that the vaccines don’t prevent, potentially, mild or asymptomatic infections. But they do prevent symptomatic infections as well as serious disease. And so if a child is vaccinated, then it is more likely that among other vaccinated populations, that they would be able to go without their masks and maybe not have to distance either because among fully vaccinated individuals, the risks of infection are pretty low.

Are there any side effects that young children may experience after being vaccinated?


YVONNE MALDONADO: Yes. The most common side effects are pain and redness at the side of injection. That generally lasts about a day or so, and then other side effects are like those seen in adults, which are low-grade fever, mild headache and fatigue. And those, again, generally occur within a day or so after vaccination and generally only last about a day or so as well. But there are very, very rare side effects. And this comes from the Pfizer vaccine, which is the only one that’s licensed for children under 16. So the Pfizer vaccine is now available under emergency use for 5- to 15-year-old children. And people 16 and older have full approval for these – the Pfizer vaccine.

But we know that for the mRNA vaccines, which also includes the Moderna vaccine, there is – in clinical trials, there have been noted a risk for heart inflammation called myocarditis. But what we’ve seen over time is that that risk is primarily focused in the 16- to 30-year-old males. The risk is very, very low in females and in other age groups among boys and men. And these side effects of this heart inflammation are chest pain and some shortness of breath. But these symptoms can be very mild. And in general, these – some of these children have been hospitalized but have had normal return to – normal cardiac function returning very quickly after that. And the long-term studies on these people have been done showing that they have returned to completely normal heart function.

Now, the risk in the 16 and older is on the order of about six dozen cases of heart inflammation per 1 million doses given. So the risk is extremely low. And it really, again, is really only in that population. So we think that it is something that families need to think about. But the likelihood that it would happen is extremely low. It’s over – 10 to 15 times more likely that somebody would have more serious heart complications from getting COVID disease. And we know that this heart inflammation from the vaccine resolves very, very quickly with no long-term complications.

Anything else we didn’t ask, that you’d like to add?


YVONNE MALDONADO: I think it’s really important, again, for families to make sure that they give their pediatricians a call, talk to them about the vaccines and make sure they understand all about them because it is really something that will help families make a good decision about vaccination. Again, a lot of us have been studying these for about a year and a half or so, and we feel very comfortable with our children and other children being vaccinated. But it’s important for parents to feel comfortable as well. The other thing I want to make sure people understand is that during the pandemic, we’ve also seen a reduction in normal childhood vaccines, as well, because of lack of access to pediatricians’ offices and difficulty getting out because of the COVID pandemic. But we want to make sure that children also get their normal vaccines including the flu vaccine.

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