October 31, 2021 — The Stop COVID Deaths Webinar #72 tackled the topic of COVID-19 vaccination in children. This was in the wake of President Rodrigo Duterte’s recent directive to vaccinate immunocompromised children aged 12-17. The UP Manila NIH National Telehealth Center, Philippine General Hospital, and Philippine Pediatric Society hosted this webinar with experts elucidating on the priority issues and recommendations. On Oct. 15, the Department of Health started vaccinating this age group with Pfizer and Moderna.
Data cited by the speakers suggest that children under the age of 18 comprise about 8.5% of the reported cases with relatively few deaths. COVID-19 disease in children is generally mild with an overall good prognosis compared to adults. The real burden of the COVID-19 in children is still unknown because the symptoms are mild leading to poor reporting and testing. However, the presence of certain co-infections or underlying medical conditions such as cardiovascular disease, neurologic conditions, neurodevelopmental disorders, chronic lung disease, immunosuppression, cancer or malignancies, genetic endocrine diseases, as well as obesity and prematurity may increase the risk for severe or critical disease in children.
“The consideration for introducing vaccines in children should be based on vaccine safety and efficacy that derive from clinical trials,” stated Dr. Ma. Liza Antoinette Gonzales, consultant of the Infectious and Tropical Disease Section, UP-PGH Dept. of Pediatrics and member of National Adverse Event Following Immunization Committee.
Clinical trials and real-world experience in Israel showed that both Pfizer and Moderna produce greater or similar immune response in young adults, had a favorable safety profile, and were highly effective against COVID-19. Most of the side effects were mild to moderate, mild allergic reactions, and rare cases of anaphylaxis and immune thrombocytopenia. No unusual side effects were found.
Side effects and Myocarditis
In 12 per 1 million vaccinated individuals, reports of myocarditis, pericarditis, or myopericarditis emerge especially after the second dose. Dr. Gonzales explained that myocardial injury is part of COVID-19 infection and has been reported in 36% of hospitalized COVID-19 patients and can occur even after the patients have recovered. These patients present with chest pain, shortness of breath, or palpitations and have abnormal findings on the echocardiogram or cardiac MRI.
In cases of myocarditis that developed after vaccination, 95% were mild and recovered on their own after only about two to three days and minimal treatment. “It is important to monitor the outcome of the myocarditis in those who develop this after vaccination. There should be continued monitoring of these cases because we do not know what the long-term effect will be. We would like this information to be disseminated so that people will be aware of what to watch out for after vaccination,” Dr. Gonzales advised.
Before recommending the vaccination of children, two riskbenefit analyses weighed the ability of vaccine to prevent COVID-19 cases, hospitalization, ICU admissions, and deaths and compared this with the risk of myocarditis. The Center for Disease Control study results showed that the benefits outweigh the risk as myocarditis and pericarditis are more common when contracted with COVID-19 but are less likely with the vaccine.
The challenges in vaccination of this age group cited in the forum were constraints in vaccine supply, need for augmented infrastructure for vaccination, need for experienced care providers, and need for continuous monitoring of the long-term effects of the vaccine.
Charmaine Lingdas
Published in UP Manila Healthscape Issue No. 32, 31 October 2021
