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House Call: What we know about vaccinating 5- to 11-year-olds

Nov. 10, 2021 Updated Wed., Nov. 10, 2021 at 10:25 a.m.

Vaccination is a community effort that includes children and adults, Dr. Jeff Markin says.  (Kaiser Permanente)
Vaccination is a community effort that includes children and adults, Dr. Jeff Markin says. (Kaiser Permanente)
By Dr. Jeff Markin For The Spokesman-Review

Last week, we got another tool to help keep our children protected and back in school – safe, effective COVID-19 vaccines for 5- to 11-year-olds.

After intensive monitoring and studies, the Food and Drug Administration has authorized emergency use of the Pfizer COVID-19 vaccine for this age group. The vaccines are available at no cost to you at your choice of many nearby providers, pharmacies and clinics.

Children ages 5 through 11 will get a two-dose series, 21 days apart, at a lower dose for younger children that prioritizes safety, toleration and immune response.

It’s a big relief for many parents who want to protect their little ones. But deciding to get your child vaccinated, or to get vaccinated yourself, can be a decision with many components, too.

We want kids to be able to stay in school in-person and play sports, want to protect grandparents and younger siblings from infection and want to take the safest approach forward.

Questions are normal. Because the COVID-19 vaccine has been studied and administered under the most intensive monitoring in U.S. history, and at this point more than 3.9 billion people worldwide have had the shot over the past year, we have answers to many of those questions.

Let’s review the information on the COVID-19 vaccine for 5- to 11-year-olds and answer some of the top questions I get as a physician that help people make a decision on vaccination.

How do we know the vaccine is safe for 5- to 11-year-olds?

Safety studies show the Pfizer vaccine is safe for children age 5 and older. Clinical trials where some patients are given the vaccine and others a placebo are the main tool scientists use to determine if a vaccine is safe and effective, and it is how the Pfizer vaccine is studied in children.

The Pfizer vaccine clinical trials included 3,100 children and showed the vaccine was safe and produced a robust immune response. No serious side effects were detected in the study.

The Pfizer vaccine had a 90.7% efficacy rate in preventing symptomatic COVID-19 in the clinical trial of 5- to 11-year-olds and reduced the risk of symptomatic COVID-19 in children if they did become infected.

In addition to the 5- to 11-year-olds in the clinical trial who were studied over six months, and a shorter trial of the same ages of an equal size, we have seen the results from the hundreds of millions of Americans, including 13.4 million 12- to 17-year-olds, who have been vaccinated in the United States.

Among these large numbers, and almost a year in, we are not seeing emerging issues and any severe side effects are quite rare. The history of vaccine development tells us that any side effects that emerge usually happen within two months of the injection, and there’s not a scientific reason for us to expect that there will be effects seen further out.

Will my child have side effects? What about bigger adverse reactions?

We’ve seen, and some of us have experienced, flu-like symptoms after the COVID-19 vaccine, such as aches, fatigue, chills or a low-grade temperature. Children ages 5 to 11 may also have those same side effects.

While they may be unpleasant if you have them, those effects are a sign your immune system is responding – and they clear up within a couple of days. They are usually managed with rest, fluids and Tylenol.

There have been reports of rare side effects, including heart inflammation in people ages 12 and older. The rates of myocarditis, an inflammation of the heart muscle, and pericarditis, an inflammation of the lining around the heart, were very low: only 877 cases appeared in more than 100 million adolescents and young adults vaccinated.

Most of the cases were mild and quickly cleared up. (The study of 5- to 11-year-olds wasn’t large enough to detect extremely rare side effects such as myocarditis.)

Because children are smaller and have robust immune responses, the Pfizer vaccine for 5- to 11-year-olds will be given at a smaller dose – one-third the amount of the adult dose.

What are the risks to children and others from not being vaccinated?

While children are less likely to develop a severe illness from COVID-19, there are serious risks, and some children do become ill. Recently, children younger than 18 accounted for 19.4% of coronavirus cases in Spokane County. The number of children sent to hospitals and intensive care units with COVID-19-like illnesses in Washington reached an all-time high this fall.

The fact is the vaccine safeguards most people from getting the virus and protects them from serious illness if they do get it. The same follows for children 5 and older eligible for the vaccine. Across the United States, COVID-19 hospitalization rates among 12- to 34-year-olds are 19 times higher in the unvaccinated population than in the fully vaccinated population.

More than 1.9 million children age 5 to 11 have been infected with COVID-19 and more than 8,300 of them have been hospitalized. COVID-19 is one of the top 10 causes of death during the pandemic in this age group.

The decision to vaccinate affects everyone we interact with, not just ourselves. Unvaccinated children can spread the virus to family members, teachers and classmates, some of whom might be at a higher risk.

Vaccination is a community effort. Kids are more likely to spread infection just because they are less careful with hand washing, masks and distancing, so having kids vaccinated takes on even more importance. We are learning more and more that children can and do spread COVID-19.

An elderly patient of mine got COVID-19 from their adult son who had been infected by his own school-age child who had contracted it from school. This is how it goes given the contagiousness of COVID-19, especially the now-pervasive delta variant.

It’s still important to continue other safety measures like wearing a mask, handwashing and social distancing, but vaccination is the most effective at reducing risk.

Does this mean safer family holidays are back?

After two years of uncertainty, surges from variants and lots of big changes in schools and work, I think many of us crave some celebrating with family. Getting eligible family members vaccinated in plenty of time for gathering is the safest way to do it.

If you have questions about the vaccine, side effects and long-term outlooks, talk to your pediatrician or provider.

Dr. Jeff Markin is a family medicine physician practicing at Kaiser Permanente’s Veradale Medical Center.

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