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What pediatricians say about whether we should vaccinate children against Covid, now that we can

It was a decision that was waiting and it has already arrived. Yesterday, the Committee for Medicinal Products for Human Use of the European Medicines Agency (EMA) announced the authorization to extend vaccination against the SARS-CoV-2 with the Comirnaty preparation in children from 5 to 11 years old.

The first step is already given. Now it is up to the governments of the countries of the Union to decide if they are going to make effective the vaccination of the smallest. At the moment the Ministry of Health has not made a statement, but doubts have begun to arise among parents.

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For this reason, the Vaccine Committee of the Spanish Association of Pediatrics (CAV-AEP) has made a statement with two objectives: the first to show its favorable position to the vaccination of the minors, and second to clarify the logical doubts of the fathers and mothers.

The positioning is clear. Once the vaccine is approved by the Spanish Agency for Medicines and Health Products (AEMPS), the Vaccination Committee of the AEP recommends the vaccination of all children in this age group based on the following points:

Frequency of infections and transmission in children

Pediatric experts acknowledge that it is not known exactly what percentage of children has been infected by SARS-CoV-2, “given that up to 50% of cases may be asymptomatic.”

Contrary to what was thought at the beginning of the pandemic, “children have not been the group that has most influenced the community behavior of SARS-CoV-2 infection.”

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The scientific evidence obtained during all these months has revealed that children become infected and transmit the disease to a lesser degree than adults.

In fact, according to the AEP, “within children, both the transmissibility of infection and the possibility of becoming infected are lower in younger children than in adults and adolescents.”

These differences between the age groups may be due to the behaviors of each one. The little ones spend more time at home or outdoors, while as they grow older it is more normal for them to engage in group activities, which increases the risk of infection.

“In the same scenario, the youngest children are infected at a rate equal to that of adults. This means that, in the current circumstances, in which children represent a substantial proportion of the unvaccinated population, the infection can move towards them and they can become a fundamental link for the circulation of SARS-CoV-2 ”, the experts explain.

Severity of the disease in children

Fortunately, the percentage of children seriously affected by the coronavirus is much higher than in adults. And if we talk about lethality, the number of deaths is extraordinarily low.

According to data from the AEP, in Spain, the rate of hospitalizations in children is 4-6 per thousand infected, that of admissions in pediatric ICUs of 3-4 / 10,000 and the mortality rate extraordinarily low, of 2-4 out of every 100,000.

“All in all, and taking into account that a large number of children have acquired the infection since the beginning of the pandemic, there have been, in our country, at least 6,000 hospitalizations, 300 PICU admissions and 37 deaths from Covid-19 , half of them in children under 10 years ”, emphasize the pediatricians.

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This load of disease by SARS-CoV-2 justifies, in the opinion of the CAV-AEP, the vaccination of all children, provided that there are vaccines with appropriate immunogenicity, effectiveness and safety.

Vaccine preparations and risk / benefit balance

There are currently two vaccines approved for children 12 years and older, the Comirnaty vaccine (Pfizer & BioNTech) and the Spikevax vaccine (Moderna).

Both have shown a 100% efficiency and few side effects that in clinical trials have been mainly local reactions at the injection site, headache and fatigue.

On October 29, 2021, in the United States, the FDA approved the Comirnaty vaccine for children 5 to 11 years of age.

“The vaccine approved for these ages contains only one third (10 μg) of the mRNA of the vaccines approved for older children and adults (30 μg),” they explain. This same vaccine has also been approved in Canada.

The emergency authorization of the EMA vaccine based on data from an ongoing study, which shows that the immunogenicity is similar to that of vaccinated older children and the efficacy against Covid-19 of 90.7%.

And based on these data, Spanish pediatricians assure that “it is a safe vaccine, whose side effects have been mild and have been limited to pain and swelling at the injection site, fatigue and a low fever.”

And myocarditis?

One of the issues that can create suspicion among parents is the cases of myocarditis, few, which have occurred after vaccination with Moderna in children 12 and over.

The pediatricians of the AEP explain that «The frequency of this complication is 1-5 cases / 100,000, it appears, above all, between 2 and 4 days after the second dose and it occurs more frequently in males aged 16-29 years».

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“Even considering this complication, the benefit / risk balance is clearly favorable to these vaccines in adolescents, since myocarditis is more frequent after infection than after vaccination,” the experts assert.

Pediatricians say ‘yes’ to the vaccine

After analyzing all these data, the specialists of the Vaccine Committee of the AEP have it clear. The most advisable thing is to vaccinate children.

And they emphasize one aspect, and that is that “the cumulative incidence of SARS-CoV-2 infections is higher in children under 11 years of age than in any other age group.

“Considering that the occurrence of myocarditis associated with mRNA vaccines decreases with the age of children, and taking into account the lower amount of mRNA in the preparation for children, it is very likely that the risk of this complication is much lower than after the vaccination of adolescents and young adults, thus improving the benefit / risk balance of vaccination in children aged 5-11 years ».

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