Transcription:
Finally.. The Covid Vaccine for 5-11 is Here

Trisha Williams: Hi, guys. Welcome to the second season of the Advanced Practice Perspectives. I'm Trisha Williams.

Tobie O'Brien: And I'm Tobie O'Brien. This is a podcast created by advanced practice providers for advanced practice providers. Our goal is to provide you with education and hopefully a little inspiration. We will be chatting with pediatric experts on timely key topics and giving you an inside look at the various advanced practice roles at Children's Mercy.

Trisha Williams: We are so glad that you're joining us. So sit back, tune in and let's get started. Today, we have the opportunity to visit with Christine Symes, a pediatric nurse practitioner from Infectious Diseases to discuss the ever-changing topic of COVID vaccines for our pediatric patients. Welcome, Christine.

Christine Symes: Hello. Thank you so much for having me. I'm really happy to get to talk with you today.

Tobie O'Brien: Yes, we are so happy to have you too. And we just want to make sure that we tell our listeners that today is November 23rd, and so this is an ever-changing topic. So we will talk about what we know as of up to today, but then past here, we don't know, right?

Trisha Williams: November 23rd, 2021, since COVID has been going on for quite some time.

Tobie O'Brien: 2021. I should have said the year. Sorry.

Trisha Williams: That's all right.

Christine Symes: Going into year two.

Trisha Williams: Yeah.

Tobie O'Brien: That's right. Well, tell us a little bit about yourself, Christine.

Christine Symes: Well, I work in the Infectious Disease Division at Children's Mercy Hospital, and I am on the inpatient side. So I work with patients that are admitted to the hospital that have concerns for infection when infectious disease is consulted. And I've been in this role for a little over three years. Luckily, I was able to get settled in to this department before a global pandemic hit, i.e., COVID.

So a special interest for me in this role has led me also to a project in our division for the last two years. It's also expanding now to other teams in the hospital around vaccinations in children that are admitted to the hospital. So I strongly believe that as pediatric providers, we should in any setting, at every encounter, offer children vaccinations if they're not up-to-date. So this has been so important for me, even before COVID, to make sure that kids are safe and healthy.

So before I came to infectious disease, I was on the bone marrow transplant team also here at Children's Mercy on the inpatient side as well. So that role was super challenging, but also very fulfilling.

So three years ago, I felt like I needed to make a change. And there was a position open in Infectious Diseases. And I had worked with them quite a bit with the bone marrow transplant population because they're immunocompromised and have a lot of unusual infections. And so it seems like a good fit and the rest is history, and it's been very exciting. So I get to see something new, learn something new every single day. I see kids in all areas of the hospital, of all age groups. So it's definitely never a boring day. I've been a pediatric nurse my entire career of 27 years and a nurse practitioner for 14 years.

On the personal side, I was born and raised in Southern California, but moved to Kansas city when I was in high school and have never wanted to leave. So, love it here in the Midwest. And we have two daughters that are all grown up now. We newly have an empty nest in our house, which is very different, but we have adoptable fur baby, Fiona, that keeps us company. And in the last year, it was very exciting. My daughter got married, so we were blessed with a new son-in-law, which has been great fun.

Tobie O'Brien: That sounds really fun.

Trisha Williams: Yeah. You'd definitely stay busy for sure. What a great change from being able to move from bone marrow transplant into Infectious Diseases. That cross or that change, I could definitely see how that's fitting in how you would find a new niche in Infectious Diseases.

Christine Symes: Yeah. So it was a difficult decision. You know, it's always hard to make a change when you've been somewhere for a long time, but it was time to make that change. And Infectious Disease seemed like a good fit and it was just a very smooth transition. And I was able to settle in and get my feet grounded before COVID, which was a blessing.

Trisha Williams: Right. Absolutely. So, you know, on the forever changing topic, like we have mentioned about COVID, the COVID vaccine for five to eleven years old is finally, finally available, which is so exciting. So that means that we are now able to vaccinate our elementary school-aged children and patients and all the way up, right? This has been forever changing I know in a lot of people's lives, but can you shed some light on how big of an impact this is now having on our community?

Christine Symes: So at the beginning of the pandemic, we felt really lucky in pediatrics that we didn't really see a lot of kids that were admitted to the hospital that were super sick with COVID. And if we saw those kids, they were older teenagers. And then, later in the summer when the Delta variant hit, that kind of all changed. And we saw kids all the way down to newborn babies that were admitted to the hospital that were quite ill, even needing some life-saving therapy, which we had just not really seen before that. So the Delta variant really kind of changed things for the pediatric population. So now, I'm so glad that we're able to offer the vaccinations, not only to the older kids, age 12 to 17, but now the school-aged kids from five to eleven. It's very exciting.

So the Pfizer vaccine was given the emergency use authorization for the kids age five to eleven by the FDA and the Advisory Committee on Immunization Practices on November 2nd. And it feels really good to offer protection to these younger kids that are going to school and out in their community and really living lives a little bit more back to normal.

So this age group of kids accounts for about 39% of COVID cases in children from birth to age 18, so about 40%. So in this younger age group, there've been about 8,300 kids in the US that had been hospitalized for COVID and about 146 deaths. So getting a vaccine to protect this population has been super important.

Some other numbers for those of you that like some data, we know in Missouri as of November 16th, 50% percent of kids of all ages are fully vaccinated. And in Kansas, that number is about 55%. And in all pediatric patients over the age of five nationally, 17% are fully vaccinated and 23% have initiated vaccines.

So it's encouraging that just in the first two weeks of offering the COVID vaccine to the younger kids, about 2.6 million doses were administered in this age group, which is about 10% of all kids in that country, which is very exciting.

Tobie O'Brien: What are some hurdles that you see for parents in accessing the vaccine?

Christine Symes: Well, I think the biggest hurdles in accessing the vaccine for kids is really just some fear and misinformation. So there is a lot of information out there about COVID coming from a lot of different places that can be confusing for parents. So I think we need to make sure that families have sources of information that are accurate and current because COVID and vaccine information has evolved and changed over time. So helping families access good information is critically important, so they can feel comfortable getting their child vaccinated.

So we're lucky in the United States that cost and availability are really not that big of barriers to getting vaccinated, which is not true in other countries around the world. So vaccines are readily available and they're free no matter where you get them. The CDC on their website actually has a phone line that you can call, a number that you can text or an email address that you can put in your location and get locations near you where you can get vaccinated or get your kids vaccinated.

And we're lucky in Kansas City, that Children's Mercy has been having mass vaccination clinics at multiple locations to get as many kids vaccinated as possible. We're also at Children's Mercy serving as a resource for any area practices that want to be vaccine providers, and we can help them navigate that process. You do have to go through some paperwork with the state to be approved as a vaccine provider, and it's a little work upfront to get set up to do that. So we have been a resource for any practice in the community that wants help going through that process or, if they have questions, we're always here to help them as well.

Trisha Williams: I have seen a lot of the local pediatrician's offices offer vaccines and things. And I know that my pediatrician's office is offering those as well. So that is an excellent resource that you're providing our community to be able to vaccinate more children.

As advanced practice providers, regardless of the subspecialty that we work in, but just being pediatric providers, all of our family and our friends, patients, just everybody we know is looking for us for guidance on these types of topics. They want to know what does the experts think. And I work in otolaryngology and I get some of these questions and I have to be like, "Let me look it up for you." But can you talk a little bit about some common fears surrounding the COVID vaccine that you have heard about and how we're able to provide guidance and helpful factual information for these questions when we have them come to us?

Christine Symes: Sure, absolutely. So I know that there's hesitancy that continues around vaccines and it can be scary and overwhelming for families. The vaccine did go through rigorous vaccine trials and the development process included all of the steps that any vaccine trial would go through to ensure that they are safe. So even though these processes seemed relatively quick, it did go through all of those steps that any vaccine would go through.

The vaccine itself does not contain any live part of the COVID-19 virus, so it can't give you the COVID-19 illness. So those symptoms that you feel after you get vaccinated are actually your immune system building that response. So when people tell me, "Oh, I had a fever" or "I didn't feel well for a day or so," I say, "Congratulations, your immune system did what it was supposed to do." So that is your immune system learning to form the antibodies against COVID and it's not actually the illness itself.

The vaccine contains messenger RNA or mRNA, which your body turns into a protein. And that protein is what makes the antibodies against the COVID-19 virus. And once your body does that, the mRNA and the protein themselves break down. So they don't enter your DNA and they don't live inside of you forever.

The vaccine contains contains some other things. It contains some fats, some salts and some sugar. But the things that it does not contain, it doesn't contain any preservatives, any food proteins, any metals or latex. So kids that have allergies to any foods like eggs or latex or any metals are safe to get this vaccine.

Some people ask if you've already had the COVID-19 illness, if you can get vaccinated, and you absolutely can and should. The only recommendation is that you wait the duration of your isolation period, which is usually 10 days or 14 days, depending on how sick you were. But after that, it is absolutely safe to get the vaccine.

There's also been some concerns raised around infertility and miscarriages due to COVID-19 vaccines. And COVID has just not been linked to miscarriages or infertility from the vaccine. So the CDC and the American College of Obstetrics and Gynecology recommend COVID-19 vaccine in pregnant women if they're otherwise eligible to receive the vaccine.

The best tool that we have to prevent infection, illness and mortality from COVID-19 is vaccination. So it's our job as providers to be knowledgeable about the vaccine or know how to get that information for families so that they can feel comfortable making that choice for their kids.

Trisha Williams: What would be some good references for us as providers to look at? You know, I know that you have mentioned the CDC, and I know Children's Mercy on their website has a significant amount of references. Is there anything else that you can add that we could look up and get knowledgeable and educated about?

Christine Symes: Yeah, so the American Academy of Pediatrics also has a whole page. So the minute you go to their website, there's a whole page for providers that you can click on for COVID information. If you want information just about the vaccine itself, you can link to it from the CDC, but you can also go to the Pfizer website and get it there. There So most big organizations, like I said, the CDC or the American Academy of Pediatrics, all have on their front-facing pages a link to just COVID information because it's so important right now.

Tobie O'Brien: Christine, I was wondering, what do you think about the parents' concern for long-term safety from the vaccine?

Christine Symes: This This vaccine was tested in thousands of children around the world and They're they're going to continue to collect data on the safety and monitoring of the COVID vaccine even going forward. So any child that has something something happen after a COVID vaccine, we report what's called a vaccine adverse event report and they collect all this data. And sometimes it's completely unrelated. So let's say my child got the COVID vaccine yesterday and they're allergic to peanuts and they accidentally ate a snicker bar today and are admitted to the hospital with anaphylaxis. Just because in the timeline, they had just gotten the vaccine, that would be reported, but obviously that's not related to the vaccine. But they continue to collect all of that information to make sure that there are no trends coming out about adverse reactions.

So the most common things that happen are right after you get the vaccine, you can always get soreness, redness, inflammation at the site of the vaccine in your arm that usually goes away within a couple of days. You can also kind of get those muscle aches. You're not feeling quite well, tired, maybe a little bit of fever. But again, those should go away within the first couple of days.

we know in the younger children, the the five to eleven year age group, in the vaccine trials, they had no serious events reported with the vaccine. So that is good news. In the older kids, there has been some concern about myocarditis, which is an inflammation of the heart muscle and pericarditis, which is an inflammation of the outer lining of the heart. This has typically affected young males around the ages of 16 to 19. And the incidence was about 15 in 100,000 who got the vaccine developed mild myocarditis after the second shot generally. The vast majority of these cases were mild and eventually resolved. And the researchers found that myocarditis was actually more likely to happen if you got COVID illness or other viral illnesses. So we know that there's other viral illnesses out in the world, like enterovirus, influenza, that can cause myocarditis as well. So typically with the vaccine, those incidences of myocarditis were milder and were seen in the older male patients, but not in our younger kids.

Trisha Williams: I read those statistics. And it was very enlightening to read those and to know, and it was more comforting. I have a 15-year-old. So those statistics were very comforting to know. I mean, some of these things can just happen, right? And so, I think it's very important as pediatric providers that we educate ourselves and know the statistics. So when family members or our patients are like, "Hey, what's your opinion? What's your thought?" We can really give them knowledge to help guide their decision for the vaccine, because we have to move forward and get out of this pandemic. So I really appreciate all of your knowledge on this. This is amazing.

Christine Symes: Yes, Yes, especially in a younger age group, it was so exciting that in the vaccine trial, that the COVID vaccine has been 91% effective in preventing COVID infection in children. So not just illness or hospitalization, but 91% of those kids are not even going to get infected with with the virus. So, overall, it's been proven to be very safe and it's very very exciting that it is just giving really robust protection to kids.

Trisha Williams: Yeah, That is very exciting. I think another question that came to my mind just now is that, you know, we we know as providers to go and you gave some excellent resources for us as providers, but to send families to like the American Academy of Pediatrics' website. I think some of the verbiage and things may be a little intimidating maybe. I don't know if that's the right word, but for them to read it. So what are some family resources because social media and different websites as, you know, mommy mommy blogs and things like that, I I feel like is where a lot of our families are getting their information. So where could we point our families to get very good information and accurate information?

Christine Symes: so I I think it's just important to refer families to a trusted healthcare resource. So in Kansas City, Children's Mercy Can can absolutely be that. We have on our public facing page, again on the very first page, a link to to COVID and it has lots of information for families that has categorized in nice, neat neat, little categories so if they want information about the vaccine or information about safety or about hospitalization, so they can get that information and it's really geared towards and written for families.

I think their health, healthcare provider, their primary care providers should absolutely have some good resources that that they can give to families and they should be getting that vaccine information sheet whenever they get a vaccine for their child that has information that is written in language that's for families with information about the vaccine. So I would say to go to your trusted healthcare providers Or to a site like Children's Mercy or your local children's healthcare facility, because I think most institutions are doing a really good job of having that information right upfront for families to see as soon as they they are searching their websites.

Trisha Williams: Perfect.

Tobie O'Brien: Yes, absolutely. I am so thankful that it is available and hopefully we will get closer and closer to having this be a memory, right?

Christine Symes: I I hope so.

Tobie O'Brien: I hope so someday. We really appreciate your time and your expertise today, Christine.

Christine Symes: Thank Thank you so much. It was very exciting to talk with you. I'm I'm sure as COVID evolves, you'll have to have another topic on this, sometime in the next year or so, because it's always changing. But let's hope that we are on the better side of it for sure the next time.

Tobie O'Brien: Yes. I hope so too. Well, we like to end each episode with the same question. So we are going to ask you today, what is the best overall piece of advice you've heard lately or read lately? And it can be pertinent to this topic we talked about or just in general life.

Christine Symes: So I'm not usually one that makes a New Year's resolution, but 2020 was really a challenge for, I think, everyone. So I was reading an article at the very beginning of 2021 about developing a personal mantra. So, in this article I was reading, it was talking about the three G's and how they apply to almost any life situation.

So those three G's were grace, gratitude and grit. And so I put those words on a letter board in my closet. So I see them every morning when I get dressed and every night before I go to bed and they have just been really great reminders for me.

So, the first G was grace, so giving grace to not only other people, because these are really stressful times and I think everyone's going through a lot, but remembering to give that grace to myself as well. I think as providers, we feel like we have to be everything to everyone all the time. So trying to give myself a little bit of that grace has been a good lesson.

And then just simple gratitude and sometimes on days that are really hard, it can just be something like noticing a really pretty sunset or the fall leaves last week were just beautiful. And there's really good good neuroscience evidence around if you think of something that you're grateful for every day, it actually retrains your brain to look for those things. So it's just good mental exercise to do that every single day.

And then grit, if all else fails, we've gotten through everything in the last couple of years. so I know that I can continue to do that. So I just think of those three words and they they have been really helpful to help me get through every single day this year.

Trisha Williams: I love that. Grace, gratitude and grit. I need that mantra in my closet too, Christine. That's fantastic. I love that.

Tobie O'Brien: I'm looking at a space in my closet right now where I think I'm going to just paint it or write with a big marker.

Christine Symes: There you go.

Tobie O'Brien: Seriously, I love it.

Trisha Williams: I do too. Well, Christine, thanks so much again for joining us. And listeners, Thanks for tuning in today. If you have a topic that you would like to hear about or you are interested in being a guest, you can email us at tdobrien@cmh.edu or twilliams@cmh.edu. Once again, thanks so much for listening to the Advanced Practice Perspectives Podcast.