The Food and Drug Administration recently approved the Pfizer COVID-19 vaccine for use in adolescents age 12-15. It’s a big development in the fight against the disease, but it also raises questions for many parents. Here are answers from one of the most trusted experts in the Intermountain West, Andrew Pavia, MD. He is the Chief of Pediatric Infectious Disease at the University of Utah and Director of Epidemiology at Intermountain Primary Children's Hospital.
- I thought older people were most at-risk. Why do we need a vaccine for young people?
- Is it safe for young people?
- How was the vaccine tested in adolescents?
- What are the side effects for kids?
- Any serious complications?
- Is there anything we should look for after vaccination?
- What complications can kids have if they don’t get the vaccine, and get sick with COVID-19 instead?
- Does the vaccine protect against variants of the virus?
- The vaccine was authorized for emergency use. Does that mean it skipped the normal safety reviews?
- Do kids really spread the disease?
- Are there any other benefits to getting the vaccine?
- Will this affect schools?
- Should kids continue masking?
- Can we get the COVID vaccine when we get the other vaccines my child needs?
- Will we reach herd immunity if kids ages 12 and older get the vaccine?
- Will the vaccine be approved for kids under age 12?
- What if I still have concerns about my child being vaccinated?
- Should my child wait a while, just until there are more studies available?
We often talk about how children are at lower risk of severe disease from COVID-19, but low risk doesn't mean no risk. We've had well over 400 children hospitalized in Utah and two deaths. Nationally, more than 300 kids have died and that may be an underestimate. That's at least 50 percent more than in our worst flu epidemic. Having a vaccine approved for kids ages 12 and up is great news and a really big deal. It’s probably the best news we've had since the first vaccine results last November. Vaccination for teenagers is what we need to get ahead of the pandemic.
I realize that not every parent is initially comfortable with the idea of getting a COVID vaccine for teenagers. I’ve spent a lot of time looking at the data that was just presented to the Food and Drug Administration. I can say that this really is clearly a safe and effective vaccine. Everyone in my family has been vaccinated – that’s how confident I am about it.
Last fall, once it became clear that the vaccines were effective and safe for adults, both Pfizer and Moderna started trials in adolescents. Some got two doses of the vaccine, just like adults do, and the rest got a placebo. Blood was drawn before they started the study, two weeks after the first shot, and then another month after the second shot. The kids were followed very closely for two to six months. Out of about 2,600 children in the trial, there were 16 cases of symptomatic COVID disease among those who had never had COVID, and all of those cases occurred in the unvaccinated children. That means the vaccine was 100 percent effective at preventing infection. Moderna has only shared their teenager data, but they also report 100% efficacy.
Virtually everyone gets a sore arm just as with adults, and there can be some redness and swelling. The more bothersome side effects that some people experience are fatigue, muscle aches, joint aches, fever, and headache. Usually these go away pretty quickly. About 20-30 percent of people say they changed their activities slightly due to side effects after their second dose. It's okay to take Tylenol or ibuprofen to relieve the symptoms. Remember, these symptoms are a sign that young adults and teenagers have a vigorous immune system that is responding well to the vaccine.
So far, the only severe complication we've seen is rare anaphylactic [allergic] reactions at a rate of about a few per million. Those reactions are well handled by healthcare providers at the locations where the vaccines are given. Is that the only possible long-term thing that could happen? No. We don't know what other rare problems might be observed when millions of teens are vaccinated, but we do know that the risk of getting the virus or having complications from the virus is much higher.
Swelling of the lymph nodes, particularly in the armpit or neck can occur. This may last for a few days but is usually not a problem. If that area is very red or swollen, or if the nodes are bothersome, you should probably have a doctor take a look at it. Some people have gotten persistent rashes. They seem to be pretty benign and they go away, but it can be kind of surprising to get them. If there's any question about the severity of the side effects, please talk to your pediatrician or family doctor.
One scary thing is that many people suffer with symptoms related to COVID for months after the infection is gone. It doesn't seem to matter how sick you got when you were originally infected. One study reported that up to half of all kids who get COVID end up with symptoms like fatigue, decreased exercise tolerance, difficulty sleeping or “brain fog” that persist for at least two months. I think that’s going to prove to be an overestimate, but it happens to a lot of kids. You don't want your kids to be fatigued and failing out of their classes and unable to compete in their sports for several months. The vaccine can prevent that.
One of the best things about the vaccines is that they generate good protection against many of the variants. That's important because natural infection with an older virus does not provide really great protection against the variants. We're seeing people who were previously infected, usually several months earlier, get infected with the new variants and sometimes have pretty significant illnesses. That's one huge advantage of the vaccines over natural infection.
It’s now clear that older children spread infection efficiently and can play a big role in community spread. We’ve seen that when there are surges of infection in high school and college-aged patients, that's followed within a week or two by a surge in infection in the rest of the population. Teenagers interact with their friends all the time and with other people in the community. These close interactions allow them to be effective spreaders. You may have heard that young children, that is preschool age, are a little bit less likely to spread infection than adults are, and that's true. But the older you get in the teenage years, the more biologically you're like an adult.
The most important thing is that young people are protected, but another huge benefit is that they get to return to a pretty normal life: If you’re vaccinated, you rarely need to mask, you can go to sleepaway camp, you can hang out with your friends, and your family can travel together.
One other benefit (which may actually be more important to adolescents who care about saving the world than it is to jaded adults) is that by being vaccinated, they protect people around them. They help bring the pandemic to an end. They protect their circle of friends, relatives, grandparents, and their community.
If students get vaccinated, high schools and middle schools will see fewer outbreaks and have less need for testing and masking. In my perfect world, every high school student would be vaccinated and then high school would look exactly like it did before the pandemic. It's going to take a lot of work to get there, but that would be the best thing that we could do for teachers and students.
Here we are really talking about unvaccinated kids. Outdoor activities are generally safe to do without wearing a mask. There are a few exceptions to that, such as contact sports where you might actually get each other's saliva in your face. But for indoor activities – particularly those where you're mixing vaccinated and unvaccinated people, or where there's poor ventilation – I think teenagers should still be masking until they're vaccinated. Protection starts about two weeks after your first dose, but it's not really full protection until about two weeks after your second dose; that's really when kids can do pretty much anything safely.
The really good news is that the Centers for Disease Control has recommended we no longer have to separate vaccines. Kids between 11 and 12 who are usually going into junior high need several vaccines. That includes a meningococcal vaccine, a pertussis-tetanus booster called a Tdap, and their two doses of HPV vaccines. We can safely give those vaccines together, but it really is sort of a personal preference question. Do you want two sore arms and two vaccines on one day, or would you like to separate them? I think, as a parent, it's probably easier to get everyone scheduled and get everything done together, but it may increase the chance that for a day or two a kid may feel kind of “punky”.
I think the term “herd immunity” has been so abused that we should retire it. We are probably not going to get to some magic point of herd immunity where the virus cannot spread anymore, so I don't think that's a useful concept anymore. But the higher level of community immunity we can reach, the less spread there will be, the fewer restrictions we need on our activity, the less chance that we'll have new surges with the cold weather or with variants. But with about 28 percent of Utah's population being under the age of 18, we have to get a significant proportion of children vaccinated. Among those children, I think the most important group to vaccinate is those aged 12 to 18. Most of our pediatric hospitalizations are in that age group, and they are the ones who suffer the most with long COVID. And because they’re out and about being social or going to work, they also are the ones most likely to spread it.
I think the most important thing is for people to talk to their healthcare provider about the safety of the vaccine, the efficacy, and what it means for youths. After that, my advice would be to get your kids vaccinated soon so they can have a normal summer and participate in a lot of activities they’ve been missing.