Paediatricians have come out in support of the COVID-19 vaccination for children aged five to 11 years old, with their association noting it is 90 per cent protective against one of the top 10 causes of death in this age group in the US.

Underlining the vaccine’s safety, the Maltese Paediatric Association said in a statement that immunisation reduced the burden of disease in this age bracket and the direct health risks associated with the infection, especially for children at risk of severe illness due to underlying medical conditions.

Children aged five to 11 became eligible for the vaccine in mid-December, and vaccination of children in this age group is currently underway.

Paediatricians added that vaccinating children would also be helpful in planning eventual relaxation of in-school protection measures, such as masks and social distancing, as well as a reduction in schooling disruptions and the need for quarantine, all of which have affected children’s well-being, the doctors said.

Their association cited, among the reasons for its support, the fact that serious complications from the infection could still occur in healthy children even though they were uncommon.

The approved vaccine has been shown to be safe when used in several million children in the US, the paediatricians ensured.

Apart from its protection of children from COVID-19 infection during the pandemic, the association also listed as reasons for its endorsement this age group’s good response to the jab.

The risk of myocarditis (inflammation of the heart) was extremely low, and could still occur with COVID-19, they explained. 

Outlining its rationale, the association said children aged between five and 11 were “at least as likely to be infected with SARS-CoV-2 as adults”. 

They were at risk of severe illness from COVID-19, although most children have mild symptoms, the most common being fever, headache, fatigue and sore throat, or are asymptomatic.

More young children being hospitalised

However, the association continued, the hospitalisation rate for this age bracket was increasing, with a nine-fold rise in the weekly hospitalisation rate from 0.025 to 0.4 per 100,000 population noted between July to September in Europe.

The association noted that 399 children were admitted to hospital during this period, with 10% needing intensive care unit admission, while two deaths were reported.

COVID-19 infection accounted for 1.7% of deaths in children of this age group and 0.1% of all COVID-19 deaths.

Disease severity among children hospitalised with the infection was comparable to influenza, but COVID-19 was associated with a longer hospital stay, higher risk of admission to ICU and higher risk of ventilation, the doctors highlighted.

Disease risks

Children with certain underlying conditions were at higher risk of serious infection and hospitalisation, they pointed out, adding that risk factors for this included older age, obesity and pre-existing conditions, such as type 2 diabetes, heart and pulmonary diseases, and neurologic, neuromuscular and neurodevelopmental (especially Down syndrome) conditions.

Multisystem Inflammatory Syndrome in Children (MISC-C) was a severe hyperinflammatory condition that could arise two to six weeks after infection, with a frequency of 100 to 600 cases per million infection, the doctors said.

Almost 40% of these cases occurred in children aged six to 11, and 60 to 70% of patients needed admission to ICU.

Long COVID

Long COVID was also seen in children, with about 8% experiencing continued symptoms more than 12 weeks after infection.

The most common symptoms in these cases were insomnia, trouble concentrating, muscle and joint pains and a cough.

In giving their blessing to the vaccine, the paediatricians also considered the mental well-being of children, saying it too has been affected by the indirect effects of the pandemic, namely the disruptions in schooling, play, sports and family routines and the separation from family members.

Immunisation of children could also lead to a significant reduction in the overall virus circulation in the community, especially in countries where immunisation rates were high, the association concluded.

About the vaccine

The Comirnaty vaccine, produced by Pfizer and BioNtech, was approved for use in children aged five to 11 by the US Food and Drug Administration agency (FDA) in October and by the European Medicines Agency (EMA) the following month. 

Children are given a third of the adult dose (10 micrograms instead of 30) as an intramuscular injection in the upper arm in two doses at three weeks apart. 

This vaccination schedule produces the same immune response and antibody levels as in adults and is 90.7% effective in preventing COVID19 infection in children, the doctors explained.

Data released by the Centre for Disease Control this week confirmed most side effects from the vaccine (97%) were not serious, with vomiting, fever, fainting, dizziness, headache and fatigue being the most common. 

Myocarditis was observed in 1.12 cases per million children receiving the vaccine (eight children in total), with a mild clinical course overall. 

Less than 10% of children missed school, or had to seek medical attention (1%), but reactions following the second dose were slightly more frequent, according to reports.

Facts and figures

Over 1.9 million cases of COVID infection in children have been reported in the US since the start of the pandemic in March 2020, with the rate of infection in this age group increasing from 5.9 to 65 per 100,000 population between July to October 2021 in Europe.

This marked a rise from 3.8% to 11.2% of weekly cases over the same period, the Maltese Paediatrics Association highlighted.

Following its FDA approval in the US, seven million doses have been administered there in the five to 11 age group, and after its EMA approval in Europe, many countries have started to offer vaccination too. 

Malta began its drive to vaccinate children last month, following immunisation of those aged over 12 in summer.

Questions to the Health Ministry about the uptake so far have not yet been answered.