By Shelly Senders, MD

As of August 12, 2021, 4.41 million American children have tested positive for COVID-19 since the onset of the pandemic, representing 14.4% of the total cases.  Symptoms have, by and large, been mild with fever, cough, congestion and runny nose being the most common.  18% of pediatric COVID-19 cases have been asymptomatic (showing no symptoms).  

But some cases of COVID-19 in children have had more severe outcomes.  MIS-C or multisystem inflammatory syndrome in children is a rare condition that has been diagnosed in 4,400 children with cardiac, renal, respiratory, GI, dermatologic and neurologic side effects.  Children with MIS-C typically require hospitalization.  Risk factors for other, more severe outcomes in pediatric COVID-19 disease include obesity, diabetes mellitus and being a medically complex patient with underlying GI, respiratory and neurologic conditions.  (Contrary to popular opinion, asthma is not a risk factor for pediatric COVID-19 disease.)  

The Pfizer mRNA COVID-19 vaccine is the only one approved for use in children 12 years and above.  (This is not because there is anything wrong with the Moderna or J&J vaccines but simply because studies of these vaccines have not been completed in the 12–17 age group).  Studies in 5 to 11-year-olds and 6 months to 5-year-olds are ongoing.  mRNA or messenger RNA vaccines function like Snapchat.  They serve as a bullhorn that commands the cell to produce antibodies or protection against the COVID-19 spike protein, the part of the virus that is responsible for attaching to the eyes, nose or throat of patients infected with this virus.  And then, like Snapchat, they are degraded rapidly by the normal healthy cell such that they cannot be measured 72 hours after the vaccine has been administered.  

Is the Pfizer COVID-19 vaccine safe in teenagers?  Yes!  Most have mild arm swelling, fever, achiness and self-limiting congestion.  While some have commented on the speed of COVID-19 vaccine research in both adults and children, there has never been a licensed vaccine that has been studied in as many adults (over 50,000) and teenagers (over 5000) for now, over a year.  There has been a small subset of teenagers who have developed myocarditis, an inflammation of the heart.  But a recent study found that the likelihood of myocarditis is 4x greater in patients who develop COVID-19 disease than in those who are administered the vaccine and most vaccine associated myocarditis is mild and does not require treatment.  The vaccine does not impact on male or female fertility or the health of a newborn.  In fact, getting the disease while pregnant puts the fetus at far greater risk than getting the vaccine.  Finally, COVID-19 vaccine does not contain any live vaccine and therefore cannot possibly transmit COVID-19 disease.  

So why vaccinate your teenager and why consider vaccinating your elementary age or toddler age child?  Whether it was made in a lab or it jumped from bats, COVID-19 disease is not a typical human disease.  And while so far, it has produced relatively mild symptoms in children, what we have seen from some of the variants or mutations of the disease is that it is an ever-evolving disease whose long term side effects are unknown.  

Most studies to date show that COVID-19 disease is a far worse option than any of the side effects seen with the vaccines.  While we cannot predict FDA approval or CDC recommendations for vaccination in the youngest of children, it is critical that we conduct trials in these age groups to ensure that our children are protected should the next variant start targeting them with a more severe disease.       

Shelly Senders, MD is a board-certified pediatrician and the founder and CEO of Senders Pediatrics in South Euclid.  Call them at 216-291-9210 to make an appointment or for more information visit www.senderspediatrics.com.