COVID can infect, sicken and kill small children, too...and leave long-term effects
CLINICAL TRIALS for Covid-19
vaccines aren’t expanded soon to include children, it’s unlikely that even kids
in their teens will be vaccinated in time for the next school year.The hurdle is that Covid vaccine makers are only in the early stages of testing their products on children.
The Pfizer vaccine authorized for use by the Food and Drug Administration two weeks ago was greenlighted only for people ages 16 and up.
Moderna just started trials for 12- to 17-year-olds for its vaccine,
likely to be authorized later this month.
It
will take months to approve use of the vaccines for middle- and high
school-aged kids, and months more to test them in younger children. But some
pediatricians say that concerns about the safety of the front-runner vaccines
make the wait worthwhile.
Although
most pediatricians believe the eventual vaccination of children will be crucial
to subduing the Covid virus, they’re split on how fast to move toward that,
says Dr. James Campbell, professor of pediatrics
at the University of Maryland School of Medicine’s Center for Vaccine
Development and Global Health. Campbell and colleagues say it’s a matter of
urgency to get the vaccines tested in kids, while others want to hold off on
those trials until millions of adults have been safely vaccinated.
Much
of the debate centers on two issues: the degree of harm Covid-19 causes
children, and the extent to which children are spreading the virus to their
friends, teachers, parents, and grandparents.
Covid-19’s impact on children represents a tiny fraction of the suffering and death experienced by vulnerable adults. Yet it would qualify as a pretty serious childhood disease, having caused 154 deaths and more than 7,500 hospitalizations as of Dec. 3 among people 19 and younger in the United States.
Those numbers rank it as worse than a typical
year of influenza, and worse than diseases like mumps or hepatitis B in
children before the vaccination era.
Studies
thus far show that 1 to 2 percent of children infected
with the virus end up requiring intensive care, Dr. Stanley Plotkin, professor
emeritus of pediatrics at the University of Pennsylvania, told a federal panel. That’s in line with
the percentage who become gravely ill as result of infections like Haemophilus
influenza type B, or Hib, for which doctors have vaccinated children since the
1980s, he pointed out.
Campbell, who with colleagues has developed a plan for how to run pediatric Covid vaccine trials, points out that “in a universe where Covid mainly affected children the way it’s affecting them now, and we had potential vaccines, people would be clamoring for them.”
The
evidence that teens can transmit the disease is pretty clear, and transmission has been
documented in children as young as 8. Fear of spread by children
has been enough to close schools, and led the American Academy of Pediatrics
to demand that children be quickly
included in vaccine testing.
“The
longer we take to start kids in trials, the longer it will take them to get
vaccinated and to break the chains of transmission,” said Dr.
Yvonne Maldonado, a professor of pediatrics at Stanford University
who chairs the AAP’s infectious disease committee. “If you want kids to go back
to school and not have the teachers union terrified, you have to make sure they
aren’t a risk.”
Other
pediatricians worry that early pediatric trials could backfire. Dr. Cody Meissner, chief of pediatric
infectious diseases at Tufts Medical Center and a member of the FDA’s advisory
committee on vaccines, is worried that whatever causes Multisystem Inflammatory
Syndrome in Children, a rare but frightening Covid-related disorder, might also
be triggered, however rarely, by vaccination.
Meissner
abstained from the committee’s vote on Dec. 10 that supported, by a 17-4 vote,
an emergency authorization of the Pfizer vaccine for people 16 and older.
“I
have trouble justifying it for children so unlikely to get the disease,” he
said during debate on the measure.
But
panel member Dr. Ofer Levy, director of the Precision Vaccines Program at Boston
Children’s Hospital, said the 16-and-up authorization would speed the vaccine’s
testing in and approval for younger children. That is vital for the world’s
protection from Covid-19, he said, since in the United States and most places
“most vaccines are delivered early in life.”
While
vaccines given to tens of thousands of people so far appear to be safe, the
lack of understanding of the inflammatory syndrome means that children in any
trials should be followed closely, said Dr. Emily Erbelding, director of the
Division of Microbiology and Infectious Diseases at the National Institute of
Allergy and Infectious Diseases.
Under a 2003 law, vaccine companies are
required eventually to test all their products on children. By late last month,
Pfizer had vaccinated approximately 100 children 12-15 years of age, said
spokesperson Jerica Pitts.
Moderna
has started enrolling 3,000 children 12 and over
in another clinical trial, and other companies have similar plans. Assuming the
trials show the vaccines are safe and provide a good immune response, future
tests could include progressively younger children, moving to, say, 6- to
12-year-olds next, then 2- to 6-year-olds. Eventually, trials could include
younger toddlers and infants.
Similar stepdown approaches were taken to test vaccines against human papillomavirus (HPV), influenza and other diseases in the past, Erbelding noted. Such trials are easiest to conduct when researchers know that a measurable immune response, like antibody levels in the blood, translates to effective protection against disease.
Armed with such knowledge, they can see whether children were
protected without them having to be exposed to the virus. Federal scientists
hope to get that data from the Moderna and Pfizer adult vaccine trials, she
said.
Vaccine
trials geared to tweens or younger children may involve testing half-doses,
which, if protective, would require less vaccine and might cause fewer
incidents of sore arms and fevers that afflicted many who’ve received the
Pfizer and Moderna vaccines, Campbell said.
But
unless additional studies begin quickly, the window for having an
FDA-authorized vaccine available before the next school year “will
be closed even for our oldest children,” said Dr. Evan Anderson, a pediatrics professor at
Emory University. “Our younger children are almost certainly going into next
school year without a vaccine option available for them.”
In
the meantime, teachers are likely to be high on the priority list for vaccination.
Protecting school staff could allow more schools to reopen even if most
children can’t be vaccinated, Erbelding said.
Eventually,
if the SARS-CoV-2 virus remains in circulation, governments may want to mandate
childhood vaccination against the virus to protect them as they grow up and
protect society as a whole, Plotkin said.
In
the 1960s, Plotkin invented the rubella vaccine that has been given to hundreds
of millions of children since. Like Covid-19, rubella, or German measles, is
not usually a serious illness for children. But congenital rubella syndrome
afflicted babies in the womb with blindness, deafness, developmental delays,
and autism. Immunizing toddlers, which, in turn, protects their pregnant
mothers, has indirectly prevented hundreds of thousands of such cases.
“We
don’t want to use children to protect everyone in the community,” said Campbell.
“But when you can protect both children and their community, that’s important.”
And
while a coronavirus infection may not be bad for most children, missed school,
absent friends, and distanced families have caused them immense suffering, he
said.
“It’s
a huge burden on a child to have their entire world flipped around,” Campbell
said. “If vaccinating could help to flip it back, we should begin testing to
see if that’s possible.”
Arthur
Allen reports for Kaiser Health News.
This
story was produced by KHN,
which publishes California Healthline, an editorially
independent service of the California Health Care Foundation.
This article was originally published by Kaiser Health News and is republished here under a Creative Commons license.
Image credit: Diana Rivera |
