“It is critical that we protect our children and teens from COVID-19 infection and the complications of severe disease,” CDC Director Rochelle P. Walensky, M.D., M.P.H., said in a statement. “…This booster dose will provide optimized protection against COVID-19 and the Omicron variant.”
About 8.6 million adolescents ages 12-15 years (half of this age group) are fully vaccinated, according to the CDC. About 5 million of them are eligible for a booster. These doses can be given five months after the primary series and must use the Pfizer-BioNTech vaccine. The dosage is based on the child’s age at the time of the booster not the time of the primary series.
While effectiveness of the Pfizer-BioNTech vaccine primary series for adolescents is high, experts say they are concerned about waning effectiveness and the surge of cases caused by the omicron variant.
“I certainly think infection and transmission are impacting our ability for individuals to function, so keeping our schools open, keeping hospitals open, keeping businesses open, keeping communities open, all of this to me is critical,” said Advisory Committee on Immunization Practices (ACIP) Chair Grace M. Lee, M.D., M.P.H., associate chief medical officer for practice innovation at Stanford Children’s Health.
Data continue to show the vaccine is safe for children and adolescents, with most side effects being mild to moderate and ranging from injection site pain and fatigue to headache, myalgia and chills. While myocarditis has been reported in a small percentage of cases, it also is mostly mild. Data from Israel presented Wednesday showed two myocarditis cases among more than 40,000 Pfizer-BioNTech booster doses administered to adolescents. Studies also have found rates of myocarditis among people 16 and older have been lower after a third dose than after a second dose.
“I have very low concern for myocarditis, vaccine-related, after a booster dose,” said ACIP member Sarah S. Long, M.D., FAAP, professor of pediatrics at Drexel University College of Medicine. “It’s far enough out, the antibody levels are not that super spike that occurs a month out.”
Much of the ACIP discussion centered around how strongly to word the recommendation. The group decided to say adolescents ages 12-15 as well as those who are 16 or 17 should get boosted instead of may get boosted.
In supporting the stronger recommendation, ACIP member Camille N. Kotton, M.D., FIDSA, FAST, clinical director, transplant and immunocompromised host infectious diseases at Massachusetts General Hospital, said the impact of children transmitting the disease to a family member who then dies is “absolutely crushing.”
Amanda Cohn, M.D., FAAP, former ACIP executive secretary, also noted the anxiety and depression adolescents have grappled with during the pandemic and the burden of being out of school if they test positive. She said reducing the potential for infection “could have a larger, immeasurable impact on the well-being of these kids.”
ACIP member Helen Keipp Talbot, M.D., associate professor of medicine at Vanderbilt University, was the lone “no” vote.
“If we had a really well-funded public health system that had the capacity to do everything, I would say yeah (a strong booster recommendation) would be great, but I really think we need to focus on the (children) who aren’t vaccinated,” she said.
Unvaccinated adolescents ages 12-17 have a seven times higher risk of contracting SARS-CoV-2 and 11 times higher risk of hospitalization than those who are vaccinated, according to the CDC.
The booster dose for adolescents capped off a flurry of vaccine actions this week. The Food and Drug Administration and CDC also signed off on shortening the interval for boosters to five months for all Pfizer-BioNTech primary series recipients. In addition, they authorized a third primary series dose of Pfizer-BioNTech for immunocompromised children ages 5-11 years.
Children under 5 years are not yet eligible for vaccination. A Pfizer representative said Wednesday the company hopes to have clinical trial data on COVID vaccines for children 6 months to 4 years in late March or early April. After failing to meet non-inferiority criteria for some children, the company is studying a three-dose series.
- AAP resources on becoming a vaccinator, preparing a pediatric practice for COVID-19 vaccination and getting paid
- CDC clinical considerations for administering COVID-19 vaccines
- Information from HealthyChildren.org on preparing children for a COVID-19 vaccine
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Editor’s note: For the latest news on COVID-19, visit http://bit.ly/AAPNewsCOVID19.
Jan. 6, 2022
Dear COVID-19 Vaccine Providers,
The following Pfizer COVID-19 vaccine authorization and recommendations were updated by the Food and Drug Administration and the Centers for Disease Control and Prevention this week:
- Moderately or severely immunocompromised children 5-11 years of age are now recommended to receive an additional dose of the Pfizer vaccine 28 days after their second dose. A booster dose is not authorized for children in this age group at this time.
- Adolescents 12–17 years of age are recommended to receive a single booster dose of Pfizer COVID-19 vaccine (purple/gray cap vial).
- Individuals 12 years and older who received the Pfizer COVID-19 vaccine as their primary series can now receive a single booster dose 5 months after completing the primary series.
- The booster interval recommendations remain the same for those who received the Moderna vaccine (6 months) and the Johnson & Johnson vaccine (2 months) as their primary series.
- People 18 years and older can continue to receive ‘mix-and-match’ COVID-19 vaccine as a booster dose after the appropriate time interval.
Thank you for your continued diligence in vaccinating all eligible Texans!
Texas Department of State Health Services