Societi Foundation statement on children, young people and vaccines for Covid-19

Published on 5 October 2021

Following the announcement from government that children and young people should be offered a vaccine, our Scientific Advisory Board has prepared a statement to answer the questions you might have. 

Q: How serious is Covid-19 for children and young people?

A: For the vast majority of children and young people, infection with Covid-19 doesn’t give them any symptoms, or sometimes just mild symptoms. If they are unwell, with care at home (such as paracetamol if they have a bit of a fever for instance) they will soon get better. A very small number of children and young people have been seriously ill with Covid-19 but this is a very small proportion of all children and young people who get the Covid-19 infection. 

Q: The position on vaccines for children and young people has changed. What is the position now and why has it changed?

A: The Chief Medical Officers of all nations of the United Kingdom have recommended that children over 12 and young people should now be vaccinated against Covid-19. 

Their advice is that:

  • young people over the age of 16 should be vaccinated with two doses of Covid-19 vaccine
  • children aged 12 to 15 without underlying serious health issues should receive one dose of the Covid-19 vaccine
  • children aged 12 to 15 years in specific risk categories including those with serious underlying health problems should receive two doses of Covid-19 vaccine.

When the vaccine roll out first started almost a year ago, this was for adults only because the vaccines had not yet been tested for use by children and young people. Since then, research on the vaccine into its effectiveness and safety for use in children has been done, showing high levels of safety. Around the world, children and young people are being vaccinated in their millions. Careful monitoring of vaccines in all age groups continues to show high levels of effectiveness and safety compared to the risk of Covid-19, including in children.

Q: What should parents consider when deciding on whether or not to get their child vaccinated?

A: Different ways Covid-19 is affecting children and young people:  The risk of serious illness from Covid-19 in children is very low, although there will be a very small number of children who become seriously ill. One of the reasons the vaccine is being offered is to protect children from this very low risk, but also to protect them from getting unwell and having to miss even more of their school education and social activities than they already have.

Vaccination does more than prevent serious infection:  The decision has been made by assessing the balance of medical benefits – reducing even further the risk of children being seriously ill. But it’s also taken into account the education benefits, social, emotional and overall wellbeing benefits too.  Preventing Covid-19 infection and illness means we can try to make sure children and young people aren’t affected further by missed school and college, missed social opportunities with their friends and missed activities. Immunising children helps stop the wider spread of COVID in the community, protecting older people such as grandparents and other vulnerable people. The decision to recommend vaccination has been made having compared the impact of these things with the rare potential side effects of Covid-19 vaccination.

How did Kawasaki Disease affect your family?  Every child and young person has a different journey with Kawasaki Disease but a history of Kawasaki Disease does not automatically mean a child or young person will be assumed as having a serious underlying health condition. Most children affected by Kawasaki Disease go on to make a full recovery and do not have lasting heart damage – most children therefore would not be considered as having an underlying serious health condition even if they have had Kawasaki Disease. 

Some children and young people will have other unrelated health issues as well which parents may need to consider.

If you are unsure about what this means for your child or teenager, speak to your usual doctor who will be able to help answer your questions.

Q: If my child or teenager has heart damage still – as a result of Kawasaki Disease – what is the advice?

A: Of the very few children and young people who develop more severe illness and need hospital treatment following a Covid-19 infection, studies have shown that the majority have underlying health conditions.

The Joint Committee on Vaccine and Immunisation recently recommended that 12-15 year olds in specific risk categories should receive two doses of Covid-19 vaccine.

All 16 and 17 year olds should be receiving their Covid-19 vaccinations in the next few weeks.

If your child or teenager has severe heart damage, you’ll be probably be very familiar with some of the language in the section that follows. You’ll likely be your son or daughters “resident expert” we are sure! But if you’re in any doubt as to whether the risk factors below affect your child or teenager, and whether this affects their vaccination, speak to your usual doctor and they will help you with further guidance.

Risk groups for “serious underlying health conditions”

The risk categories which have been identified in Children and young people over 12 years include those with “Haemodynamically significant congenital and acquired heart disease, or milder heart disease with other co-morbidity.”

A co-morbidity is second illness or condition which you have alongside another illness.

The 12-15 year olds and 16-18 year olds who should be offered two doses of the Pfizer vaccine has been considered within the British Congenital Cardiac Association and includes:- Single ventricle patients or those palliated with a Fontan (Total Cavo-Pulmonary Connection) circulation
– Those with chronic cyanosis (oxygen saturations <85% persistently)
– Patients with cardiomyopathy requiring medication
– Patients with congenital heart disease (heart disease you are born with) on medication to improve heart function
– Patients with pulmonary hypertension (high blood pressure in the lungs) requiring medication
– Patients who have undergone heart transplantation
– Patients with congenital heart disease and significant co-existing conditions e.g. chronic kidney disease or chronic lung disease.
– Any patient who was previously classified as “clinically extremely vulnerable”
– Patients who have been advised to receive Covid 19 vaccination by their cardiologist because of their specific clinical situation.

If you are unsure if your child is in one of the above categories, please speak to your GP or usual doctor who will be able to advise you.

Q: Does the advice change if a child had heart damage when first poorly with Kawasaki Disease but has now recovered?

A: If a child had heart damage when first poorly with Kawasaki Disease but has now fully recovered and is not on any ongoing medication related to their Kawasaki Disease illness, they would not be considered to fall into one of the risk categories.

Following current government guidelines, these children should be offered vaccination against Covid – 19 with a single dose of vaccine (Pfizer vaccine). If you are unsure, speak to your GP or usual doctor.

Q: Is long Covid a greater risk for children and young people that have been affected by Kawasaki Disease?

A: Long Covid is rare in children and there is no evidence to suggest a history of Kawasaki Disease means a greater risk of long Covid.

Q: Is the very small risk which has been reported, of heart inflammation following Covid-19 vaccination, greater if a child has heart damage as a result of Kawasaki Disease (whether recovered or still present)?

A: There is no evidence which suggests that previous Kawasaki Disease increases the risk of heart inflammation following vaccination.

Q: Heart inflammation sounds scary if it did happen. What else can you tell us about it?

A: Inflammation of the heart muscle (myocarditis) or inflammation of the outer lining of the heart (pericarditis) has been reported rarely following vaccination with mRNA vaccines (Pfizer / Moderna). The vast majority of children and young people will not be affected by this complication.

For the few cases that have been seen, it’s been shown that young adults, adolescents and children appear more affected than older adults, and boys are more affected than girls but the risk of this is very small indeed and reports are very rare.

If affected by this rare side effect, Myocarditis or pericarditis usually occurs within 2-3 days of vaccination (more than 90% of cases were identified within 7 days), and this happened more after the second dose of vaccination than the first.

Symptoms include:
• Chest pain or discomfort
• Fever
• Shortness of breath or pain with breathing
• Palpitations or syncope (fainting)

If these symptoms occur, seek urgent medical attention.

In the vast majority of cases the symptoms resolve rapidly with hospital treatment.
The existing evidence shows that most patients with myocarditis after vaccination respond well to treatment and recover well with no lasting effects. As a precaution, studies are underway to further understand why this is happening and what this might mean, if anything, for the longer term.

Need more help or have more questions?
If, after reading the above, you still have unanswered questions we would suggest you speak to your GP or your usual doctor who will be able to help.

 

ABOUT THIS POST: This is information issued by Societi Foundation, prepared by our Scientific Advisory Board  on 05 October 2021.

IMPORTANT NOTE: The information contained in this statement is true and accurate to the best of Societi Foundation’s knowledge and belief, and is based on the information currently available to it. This statement does not give, and should not be construed as, medical advice.