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COVID-19 Vaccines and Kids: Your Questions Answered

Vaccines to protect against COVID-19 are now available for adolescents and teens 12 and up. This is an encouraging development and a big step forward in the fight to end this pandemic. The pediatric experts at Le Bonheur Children’s Hospital know that parents want to make informed decisions about their children’s health care and may have questions about whether the vaccine is right for their child. Here to address some of those questions and concerns is Division Chief of Pediatric Infectious Diseases at Le Bonheur Children's Hospital and the University of Tennessee Health Science Center, Dr .Sandy Arnold.
Featuring:
Sandra Arnold, MD
Sandra Arnold, MD is Division Chief of Pediatric Infectious Diseases at Le Bonheur Children's Hospital and the University of Tennessee Health Science Center. 


Transcription:

Bill Klaproth: Vaccines to protect against COVID-19 are now available for adolescents and teens 12 and up. This is an encouraging development and a big step forward in the fight to end this pandemic. The pediatric experts at Le Bonheur Children's Hospital know that parents want to make informed decisions about their children's healthcare and may have questions about whether the vaccine is right for their child. So here to address some of those questions and concerns is Le Bonheur's Division Chief of Pediatric Infectious Diseases, Dr. Sandy Arnold.

This is the Peds Pod by Le Bonheur Children's Hospital. I'm Bill Klaproth. Dr. Arnold, it is always great to talk with you. Thank you so much for your time on such an important topic, COVID-19 vaccines in children. So what is the latest news regarding vaccines for kids?

Dr. Sandra Arnold: The news is great news. On May the 10th, the FDA extended the emergency use authorization for the Pfizer COVID-19 vaccine to include children down to age 12. So other vaccines that are currently available in the US under emergency use authorization are still being studied in younger children. In fact, today Moderna, one of the other companies, released some early data on their studies in children 12 to 15 years of age, and that they'll be submitting to the FDA soon. But right now, the Pfizer vaccine is the only one that's available for children 12 and older.

Bill Klaproth: Yeah, that is really good news to hear about the vaccines and that the Moderna may be coming on line soon as well. So let's talk about the Pfizer vaccine for kids 12 and older, is that different from the one adults get?

Dr. Sandra Arnold: No, it's not. It's absolutely identical to the vaccine used in adults. Once it was proven to be safe in both younger and older adults, Pfizer revised its study to include children down to 12. They're similar enough in size and their expected immune responses, so basically receive the same vaccine as adults. And what they found was that the vaccine pretty much worked exactly the same way in these children as it did in the 16 to 25-year-olds, which was the next group above them to which they were compared.

For younger children, they had to start new studies and they're looking at new doses because sometimes younger children need less vaccine. And so they're going to be looking at different doses to find the optimal dose for the various age groups. And it's possible that we might see that very young children get a smaller dose. That's the case with some flu vaccines.

Bill Klaproth: So I would imagine some parents are asking since kids haven't been getting as sick from COVID, "Does my child even need a vaccine?" How do you answer that?

Dr. Sandra Arnold: So the great news is that COVID has not affected children nearly as much as it has adults, but that doesn't mean that children are completely unaffected. When I think about this, I think about two main reasons why children need to be vaccinated. One is that they do need protection themselves because even though upwards close to a million people potentially have died of COVID-19 in this country since the outset of the pandemic, most of those are adults, but that doesn't mean that it has been entirely benign in children.

Over 300 children in this country have died COVID-related deaths since the start of the pandemic, which is anywhere from three to about 10 times as many children who could die from the flu during any given flu season. So even though the numbers are much smaller, you're talking about cutting off the life of a young person who has their entire life ahead of them. And it's a preventable death. This isn't a trivial thing. So children need to be vaccinated to protect themselves.

But in addition, vaccinating children will help limit the spread of virus to susceptible adults. And some people will say, 'Well, if all the adults are vaccinated, do the children need to be vaccinated?" And the answer still is yes, because, one, all the adults are not going to be vaccinated. And two, the vaccine doesn't necessarily work really, really well in everybody. There's still going to be vulnerable people out there, even who have received the vaccine, especially immunocompromised individuals who are children and adults.

Elderly people, they seemed to respond pretty well to the vaccine, but we know that, for example, the flu shot doesn't really work as well in older people who it really is needed to protect than it does in younger people. And natural experiments where countries have given flu vaccine to lots and lots of children have shown that that will definitely protect older people against the flu. And the same thing will be the case with this coronavirus vaccine. So they need their own protection, but they are also needed for that herd immunity effect to protect all the other vulnerable people out there.

Bill Klaproth: Yeah. So, you know, we are all in this together. And a few things you said there I picked up on, one, this is not a trivial thing; two, this is preventable. So I think we have to keep that in mind when we're talking about these vaccines. My kids are over 16 now and they are vaccinated. And I got to tell you as a parent, just the peace of mind from that alone is very comforting to me. That just really makes sense. So I know other people are saying, "Well, you know, is there enough time to know that these vaccines are safe?" So what about that?

Dr. Sandra Arnold: It's really important to know that at this point, hundreds of millions of doses of Pfizer vaccine have been given around the world and it's proven to be very safe. All vaccines and medications have potential side effects. And there have been adverse events associated with this vaccine, for example, severe allergic reactions, but they appear to be very rare.

In terms of what we don't know, people have concerns that there may be something that happens five years from now or 10 years from now from this vaccine. And that really doesn't make any sense from a scientific point of view. That is more of a worry that has been put out there on the internet by anti-vaxxers that we need years and years of experience with the vaccine in order to know that it's safe. Whereas really what the vaccine experts say is two to three months, but the adverse events that you're going to see, you're going to see fairly soon after vaccine and there aren't these unknown, strange side effects that are going to occur years later.

Bill Klaproth: Right. And as we're speaking about side effects, what are the potential side effects?

Dr. Sandra Arnold: So the main side effects of this vaccine are the ones that occur within the first couple of days after receiving the vaccine. Those of us who have had it know that you're generally get a painful arm. You may have flu-like symptoms with body aches, headaches, low-grade fever, a variety of those sorts of symptoms, the same sorts of things that you can get after a flu vaccine. And those are generally completely benign and self-resolving within 48 hours.

They may be a little more pronounced in the younger children whose immune responses are a little more robust and they are generally more prominent after your second dose because your immune system has been primed with the first dose and then the second dose causes that booster effect. Your immune system is primed and ready to go. And so those side effects occur more frequently and can be a bit more severe, but they still pass within 48 hours.

There were some concerns during the initial trials that perhaps there were some other side effects that were being seen, like Bell's palsy, which is a facial nerve palsy following vaccine. But these have not turned out to be more common among vaccinated individuals.

People might've heard on the news this week about something called myocarditis. And I just want to address that because it is out there in the media now and so people need to know what's going on. Myocarditis is inflammation of the heart muscle, and this is a disease typically associated with common viruses like Epstein-Barr virus and enteroviruses that can cause the heart not to function very well. It may cause chest pain or shortness of breath. And it is typically a self-limited condition. What people are seeing around the world right now is not the same as a viral infection of the heart. It's probably due to the immune response to the vaccine, if it is at all related and that isn't certain yet.

But around the world, people are seeing a small number of cases, generally in healthy young men, starting within a few hours to a day or two after the second dose of vaccine. These cases seem to be quite rare, but they do seem to be connected to that second dose of vaccine. But the most important thing, all the cases that I have heard about, they seem to be very mild and self-resolving. A 17-year-old complains that he has chest pain. He goes to the hospital, has some blood tests that show that his heart muscle is inflamed and then, by the next day, is perfectly fine after getting some anti-inflammatory drugs and going home.

It's important that people know that all the public health authorities and the FDA, CDC and these authorities all around the world are looking into these cases. And they are going to figure out whether they are connected based on looking at the number of cases that we normally see versus the number of cases seen in people who have received vaccine. But the most important thing to remember is that these cases are rare, probably much less common than we see heart problems in children who actually get COVID-19 and they seem to be incredibly mild with complete resolution of symptoms.

Bill Klaproth: Well, I'm glad you addressed that because that was in the news. So thank you for talking about that and explaining that to us. So that all make sense and is good news. So let's talk about women who may be trying to get pregnant. Does the vaccine cause fertility issues?

Dr. Sandra Arnold: There's zero evidence that the vaccine causes fertility issues. Some scientists raised a theoretical concern that there were enough similarities between the spike protein of the virus, which is the protein that is in the vaccine or the protein that is made from the mRNA that is in the vaccine. They were concerned. It was similar enough to a protein that is involved in the formation of the placenta, that they thought that antibodies to the spike protein could bind to this protein and prevent formation of the placenta. But there's absolutely no evidence that this is the case.

And remember that the spike protein is also found on the virus. So if this were actually happening, we would see this as a problem in people who were infected, not just in people who got the vaccine, and there has been no indication that viral infection with this coronavirus actually causes infertility. We do know that infection with this virus while you are pregnant can cause problems and has been shown to be associated with early pregnancy loss. So if you want to get pregnant, you do not want to get COVID and we would strongly recommend that you get vaccine for that reason and all the other ones that we've already talked about.

Bill Klaproth: So I've heard this one, Dr. Arnold, and quite frankly, it kind of drives me crazy. People that I know have said this to me, that they don't want to get vaccinated because they think that the vaccine will change their DNA. Can you dispel that for us and talk about that?

Dr. Sandra Arnold: Absolutely. So there's absolutely no way for this vaccine to change your DNA. I think people are nervous about it because it does contain a form of genetic material, which is mRNA, which stands for messenger RNA. And that is a genetic sequence that codes for the spike protein that is derived from the virus. But that genetic sequence is RNA, not DNA. And there's no way for your body to take RNA and convert it back to DNA. So the RNA is injected into your arm. It is then read to create the protein. The protein hangs around for a bit, your immune system responds to it. And then even that protein disappears. The mRNA is long gone by then.

Our bodies are making mRNA all the time. There's mRNA from human genes in our cells, but there's also mRNA being produced by all the other microbes that live in our bodies. So anytime you get a virus, that virus will copy itself. And it does that through the same way that ourselves copy themselves. It's a little bit different, but essentially the same process and mRNA is produced during that time. All the bacteria that live in our bowel make mRNA, that mRNA cannot harm you. It disappears very quickly. It's degraded. The protein is made, and then the protein is degraded. There's absolutely no way for that mRNA to get anywhere near your DNA or be incorporated into it.

Bill Klaproth: So these vaccines are basically doing what our bodies do naturally.

Dr. Sandra Arnold: Exactly. It's a way of sort of hijacking the immune system a little bit in order to make it respond to something without you actually having to see the whole microorganism. You can just make antibodies to the one part and that one part is not harmful to you, right? So when you see side effects due to vaccines, they're often due to the immune response, just like we were talking about with the myocarditis. That's what people are looking for. They're looking for the immune response gone a little bit crazy perhaps, where you might see side effects from that. But the actual components of the vaccine, that mRNA, that can not do you any harm.

Bill Klaproth: So that's really important to know, and that's a great answer. If you hear someone say, "I'm afraid of this," or "I'm concerned that the vaccine will change my DNA," I'm going to use that and say, "There's no way to take RNA and convert it to DNA. And this process is basically what happens in our body naturally."

Dr. Sandra Arnold: Exactly.

Bill Klaproth: That's a great answer. So thank you for that. So let me ask you this, if a child already has had coronavirus, should they still get a vaccine?

Dr. Sandra Arnold: I think that we don't know how long natural immunity to this infection will last. Certainly, when we are exposed to a virus for the first time, we have new immunity to it and we do have some immune memory from that. We make antibodies. Those only last for a certain amount of time, but there are cells in our body that have some memory of having been exposed to that virus.

But with other respiratory viruses, we can be reinfected again after those antibodies that we make to the first infection kind of wane over time. And so it's expected, especially given that we've seen people with more than one infection, that that immunity will wane over time even though we know that it does also produce some kind of immune memory and maybe the second infection isn't as bad. But it's certainly possible to get reinfected. And we think that the vaccine-induced immunity is probably more long-lasting. For one reason, because the antibody responses seem to be much higher. So if you get vaccine two doses versus having had coronavirus infection, the amount of antibody you have that can attack the virus is much higher. And so if it starts at a higher level, it's going to take longer to completely go away. So we think that even people who have been infected should get the vaccine so that they can extend their period over which they are immune.

People have talked about how we might need to get another booster dose of vaccine somewhere along the line. And that is certainly a strong possibility because the antibodies that you make in response to either vaccine or infection do not hang around in your body forever. Most children will have a good antibody response, but we are still recommending it.

And some people are saying you should wait 90 days after an infection, but really there's no absolute time period that you'll have to wait after getting an infection, but you can wait 90 days because that's basically what scientists and CDC are saying is the amount of time that you would have a reliable protection against reinfection. So people can wait 90 days or if there's a vaccine slot available and it's only been 30 or 40 days since their child had COVID, they can go and get the vaccine. It's not a problem.

Bill Klaproth: Right. So then, answer is yes if your child has had coronavirus, get the vaccine. So then what about this one? If a child had multisystem inflammatory syndrome or what is known as MIS-C as a result from COVID, do you recommend that they get a vaccine?

Dr. Sandra Arnold: This is a really tough one because nobody really knows the answer to this. The current recommendation is that children who have had MIS-C can be vaccinated, but it's a personal choice as it is with anybody trying to decide whether to get their child vaccinated. No one really knows if getting the vaccine will trigger another episode. But the same also goes for potentially getting infected again. And since we know that there's a possibility that you could be vulnerable to a second infection even after you've had MIS-C, you could argue that maybe it's better to get vaccinated. But really, nobody knows and each family with a child who has had this strange syndrome is really going to have to make a decision for themselves.

I think if it were my child, I would probably go ahead and get them vaccinated because I would be more concerned about them getting a second infection and having a similar response. But this is a really tough one. That's a very personal decision.

Bill Klaproth: So I know this next question, there's a lot of talk about it and people are kind of taking sides. Will schools require this vaccine for in-person attendance as they do for many other vaccinations?

Dr. Sandra Arnold: Schools are run by states and it's state governments that decide which vaccines are mandated for children attending public school. So this is going to be something that's going to be decided at the state level, across the country for each state. it's likely right now that no one will mandate vaccine until it is fully approved by the FDA, that is no longer only available under emergency use authorization. And that usually takes a year's worth of data on using the vaccine before they will issue that full approval.

So for the children, it probably won't be for some time before they would even consider that. It seems very unlikely to me that Tennessee will require the vaccine for schools any time in the near future.

Bill Klaproth: And then where can 12 to 18 year olds now get the vaccine? Where can they receive it?

Dr. Sandra Arnold: They can pretty much get it anywhere that adults are getting vaccines, including public vaccine sites, pharmacies, and some doctor's offices. In Tennessee, a lot of doctor's offices only have Moderna vaccine, which in only approved down to 18, and that includes pediatrician's offices. And that's because they can get that in smaller amounts. The logistics of getting this vaccine for doctor's offices is very complicated. But soon, hopefully, Pfizer will be able to ship doses in smaller packaging, but also we heard today that maybe we'll be able to be giving Moderna vaccine to younger children soon.

So it may be that very soon, when you go for a checkup, your doctor will be able to offer you a vaccine in the office, but there are all these other places you can go as well. And now, Le Bonheur Children's Hospital is offering vaccine to our outpatients as well. Currently, it's only happening on Wednesdays and there are appointments you can sign up for, if you talk to your Le Bonheur doctor or nurse.

Bill Klaproth: And then the next step is children younger than 12, so when will children younger than 12 be able to get a vaccine?

Dr. Sandra Arnold: So studies in these younger children have just started in the last few weeks. And the hope is that by the fall, there will be sufficient data to extend the EUA down to these younger groups. Maybe for the older children in these groups in September and maybe a little bit later for the very young ones down to about six months.

Bill Klaproth: And then will my child still have to quarantine if they have been vaccinated but were exposed to COVID?

Dr. Sandra Arnold: So the rule is right now that no, vaccinated people do not have to quarantine if exposed to somebody with COVID-19. If you've had past infection, that stops at 90 days after infection, but there is no time limit on that limitation for vaccinated people. So if you did have an exposure, you would not have to stay home. You will be able to continue on with your life if you're vaccinated.

Bill Klaproth: Okay. Got it. Let's talk about masks for a quick second here. Do vaccinated people still have to wear masks?

Dr. Sandra Arnold: So most people know that the CDC came out last week and said that vaccinated individuals do not need to wear masks under most circumstances, so in sort of ordinary public places, at home. But it is still recommended that you wear a mask when you're in a very crowded indoor or outdoor space, like a party or a gathering or a concert or something like that.

Bill Klaproth: Okay. Last question, where should we turn if we have additional questions or concerns about the vaccine? Where is a good place to get information?

Dr. Sandra Arnold: So there are trusted websites. It's always a good place to start at the CDC website and they have a lot of really nice information and infographics that explain these things. You can also ask your own doctor or your child's pediatrician and they will always be happy to explain things to you and give you advice.

That said, you do not need to ask your doctor's permission to go and take your child to be vaccinated. They would be more than happy to hear about it after the fact, when you show up for your next appointment with them with a vaccine card that they can then document in their chart, that you've had that vaccine.

Also on the topic of vaccines at your doctor's office, remember to make sure that your child is up to date on all their vaccines. Unfortunately, in the last year, many children were not taken to the doctor when they needed to be because people had concerns about exposing themselves and their children to COVID and many children missed vaccines this year and need to be caught up. So make sure that especially coming into the next school year, that you make sure that your child is caught up on all their vaccines.

Bill Klaproth: Such a great point. So let's say that again, remember to make sure your child is up-to-date on all their vaccines. So that's really important as well. Well, there have been a lot of questions recently asked about kids in vaccines and you have done a great job answering all of those. We are much more informed now. Dr. Arnold, thank you so much for your time in this really informative podcast. We appreciate it. Thank you again.

Dr. Sandra Arnold: Absolutely. Thanks so much.

Bill Klaproth: That's Dr. Sandra Arnold. And to learn more, please visit LeBonheur.org/podcast. And be sure to subscribe to the Peds Pod on Apple Podcasts, Google Podcasts, or wherever you listen to your podcasts. You can also check out LeBonheur.org/podcast to view the full podcast library. And of course, if you found this podcast helpful, please share it on your social channels.

This is the Peds Pod by Le Bonheur Children's Hospital. Thanks for listening.