Transcription:
What Parents Should Know About the COVID19 Vaccine for Kids

Melanie: There's no handbook for your child's health, but we do have a podcast featuring world-class clinical and research physicians covering everything from your child's allergies to zinc levels. Welcome to Kids Health Cast by Weill Cornell Medicine.

I'm Melanie Cole. And today, we're talking about what parents should know about the COVID-19 vaccine for kids. Joining me is Dr. Karen Acker. She's an assistant attending pediatrician at New York Presbyterian Hospital Weill Cornell Medical Center, and an Assistant Professor of Clinical Pediatrics at Weill Cornell Medical College Cornell University.

Dr. Acker, I'm so glad to have you with us today. What a great topic. And I imagine that they are asking so many questions. So why don't we start with a short explanation about the Delta variant and the latest information of what we know about how contagious it is, why it's more infectious. Tell us a little bit about it.

Dr Karen Acker: Well, thank you for having me so much. You are definitely right. I've been getting tons of questions. Everyone wants to know what's happening now with COVID and kids. And I kind of like to start it with a little bit of just what has brought us here, because when we started, we were able to kind of breathe a sigh of relief that perhaps kids were relatively spared from COVID. And that still, I think, is the case compared to adults. That kids are still much less likely to get infected and to get severe infection from COVID-19. But it's certainly not what it was in the very beginning, now that we've had more testing and kids are getting more exposed now, that we're not in lockdown, schools are now opening up.

And over the first nine months of the pandemic, we didn't really hear much about viral variants. Well, essentially when I think of kind of any pathogen, bacteria or virus, really when they are multiplying, they're usually changing. But it's really about how fast they're changing and whether the change is causing it to become more either aggressive or more transmissible entity. And in the first nine months of the pandemic, variants that we weren't really hearing much because I think It was a little bit evolutionarily stagnant. The virus wasn't changing that much.

And then what happened though, is that it started to change more. We started to hear about variants. And I'm sure one of the big ones we heard was that UK variant, now it's referred to as Alpha. And that was the big one that was affecting us in the spring. And finally, our rates started to come down in later spring. And then we get wind of a new variant called the Delta variant that was starting to cause severe disease in India initially starting last November, and then it became the dominant strain in the UK, and then it became the dominant strain in the United States.

And what it is is when the virus is replicating and it can change enough that, we've heard a lot about probably the spike protein. Basically, I think of it just kind of like this. There's multiple spike proteins sticking on the surface of the virus. And it's that spike protein that kind of connects to one of our receptors in our cells, so it can get inside our cells, it can cause infections. If that spike protein becomes stickier and can bind to our receptor more easily, it could potentially infect us more easily. So we found that the Delta variant is more transmissible than the prior variants that were causing infection.

Additionally, what if it not only can get into our cells and infect us more easily, what if when it causes infection, it causes more severe disease? That we're still trying to tease out. But fortunately, despite the increases in pediatric cases, we're seeing particularly in the Southern United States, two recent studies that came out of the CDC showed that while more kids are getting infected and are getting hospitalized now than before, if you really compare the pre-Delta and post-Delta time, it doesn't appear to be causing more severe disease in children.

Melanie: Well, that's encouraging for sure, because I know that we're hearing more in the media, that more kids are getting it. Can you tell us about the vaccine and for whom is it approved of as of right now?

Dr Karen Acker: So right now, the vaccine is approved for age groups starting at 12 and older, and that's particularly for the Pfizer vaccine. So right now, only the Pfizer vaccine is approved for pediatric age group. And the youngest child that can get vaccinated right now has to be at least 12 years old.

We know that, and are really hoping that, the younger age groups are going to be eligible soon. But we are recommending against bringing a younger child to get a vaccine. We've seen some patients that were, you know, maybe 11-1/2 and parents want to get them vaccinated. We are recommending that they just wait until their age group is eligible so that they can get the appropriate dose for them.

Melanie: That's an important message you just sent to parents because some of us want to speed it up a little bit, but we need to really wait until the approved age. Now, are there kids of that approved age from 12 up that should not get the vaccine?

Dr Karen Acker: So fortunately, the contraindications for getting the vaccine are pretty minimal. There's not many. The main contraindication that the CDC recommend against is if you either have a severe allergic reaction, so that can mean anaphylaxis or any really immediate reaction that happened right away after getting a prior dose of the vaccine. So if you've got your first COVID vaccine dose and had a severe reaction, you shouldn't be getting the second dose.

The other contraindication is if you have a potential severe allergy to any component of the vaccine. But really when I think of the components, there's really only one component, that I think of in the Pfizer and Moderna vaccine that you should know about, it's called polyethylene glycol and it's a component in MiraLax. So if you've given your child MiraLax, many kids suffer from constipation, if your kid has tolerated MiraLax, they do not have an allergy to polyethylene glycol.

Melanie: Oh, I'm so glad you brought that up. I remember giving my kid MiraLax, my son specifically. Now I would like you to address parents right now, Dr. Acker, who are hesitant, who are hearing all this misinformation. They're hesitant to get their child vaccinated from COVID, but yet maybe not as hesitant to go get the chickenpox vaccine or the MMR, whatever they're getting, that they've just been doing as a routine basis. But now, this one is freaking them out a little bit. Please address the misinformation, myths that you've heard and tell parents why it's so important to vaccinate our kids at this time.

Dr Karen Acker: So, with COVID has come a lot of hesitancy and fears and it's brought up a lot of issues that makes this vaccine a little bit more difficult to kind of communicate its safety compared to others. But I have such great trust in the vaccine development of this vaccine and of prior vaccines.

I mean, we know that kids have tolerated vaccines so well since this is one of the biggest public health interventions really in our generations, has shown to be extremely safe going and we know that kids have to get vaccinated before school. We bring them in for just general checkups. What makes parents I think hesitant now is that more than a year ago, we didn't know about this vaccine. And now, it's here and now, we're giving it. And some people say, "Okay, did this happen too fast? Vaccines shouldn't be developed that fast."

What I really think is that all the other vaccines took way too long to develop. And I think it shows us what we are capable of in terms of the science and the production. And also just the scrutiny that can go into it. So with this process, what happened was, is that many of the steps that usually occur in series with vaccine development happened in parallel. So it's not that they skipped steps. They just had to do some steps at the same time.

Additionally. The scientists, the productive companies, they diverted all their resources to just this. So if you have many projects that you're working on, but then you suddenly divert to just one, you're going to get it done much faster. And then also, the reason why we were able to learn so much about this vaccine is that the best time to study a vaccine and when you're gonna get the quickest results is when you have a ton of infection circulating.

So it was not that we wanted a lot of infection circulating because we've seen what COVID has done to us, but at the same point, it was the optimal time to study a vaccine and to see if it works. Other vaccines that we are testing where there's not a lot of infection out there, it takes a really long time to gather the numbers and see those results.

And then one thing I want to also add is that the scrutiny for this vaccine, I mean, I think this is probably one of the most or most scrutinized vaccine we've had. We have so many reporting systems. The CDC has created additional reporting systems so that not just doctors are reporting any potential event, but anyone who gets a vaccine can get the V-safe app and enter in how they're feeling after the vaccine.

So we have the capability of picking up extremely rare events and we have found some really, really rare events. And, what they've shown though is that they are extremely rare. And then we can look back and say, for example, you know, one of the concerns that I know and I'll bring it up because, I've seen in some cases is something called myocarditis. In some teenagers and young adults who received the vaccine, developed what's called myocarditis, which is some inflammation around the heart. And fortunately, these cases have been mild cases. They've just required some monitoring just to make sure that everything's okay. But even in the few cases I've seen, the kids have fared very well, which is really wonderful.

Then knowing though that this is an effect, we were able to go back and study and say, "Okay, We have to weigh the risk and benefit of the vaccine. And what we found though, is that COVID itself causes myocarditis and it's much more common that COVID will cause myocarditis than the vaccine. So you have to kind of weigh the risk and benefit. And I know that for my kids, I have two toddlers, four and one and a half, and I'm anxiously waiting for their age group to be eligible. And I will have absolutely no hesitation getting them vaccinated.

Melanie: Well don't wish time away because I'm telling you, it goes fast. Don't even blink. Your little two toddlers will be teenagers before you can blink, I'm telling you. But this is really such great information for parents that are hesitant. As we wrap up, first of all, do you think that even for adults and for these kids, like we want our kids to get flu shots every year. And now, especially because we don't want these mixed strains, right? I've done a few shows on these mixed little confusion now with RSV and flu and all these things happening at once. So flu shots, even more important. Do you think it'll be a booster situation? And can you please end, Dr. Acker, with why we should still be wearing masks even if we are vaccinated?

Dr Karen Acker: So with the booster question, that's kind of the big question of the moment. Currently, booster doses or third doses are available just to certain patient populations. Really, right now, it's offered to those who are immunosuppressed, either moderate or severely immunosuppressed. And the reason for that is it's really thought of as more of a third dose that in case these patients didn't develop an effective immune response because of their immune system not being as robust. The third doses should help them mount that response.

The question about the booster is for those who got the two doses and likely mounted an appropriate response, do we still need a booster to even boost that response so we can handle all these different variants? I think the answer is definitely a possible yes. But I can't say for sure, because the vaccines really are doing what they should be doing and they're preventing us from getting severe disease and getting hospitalized. And that was the goal of the vaccine. We are seeing some breakthrough infections and people are vaccinated, which are largely without symptoms or with mild symptoms. But overall, they are effective at two doses. So that's why there's a little bit of the debate going on on whether we should be offering boosters for people who've already had the two doses because the counterargument is that there are many people who haven't received any doses, and those are the ones who really need the vaccine.

So what I really want parents to know is to keep their children safe is that vaccinations are key. Everyone who is eligible to get vaccinated should get vaccinated. That will protect your kids. But until we get everyone vaccinated, our whole population, we still need to wear masks when we are indoors or unable to physically distance.

And this will protect your child not just from COVID, but also from other circulating viruses that we've seen, RSV, influenza. So until we can really get the population fully vaccinated and decrease our rates of infection. I'm still strongly advocating masks for everyone who can wear them. And that's anyone who's two years or older.

Melanie: Great information. And from the experts at Weill Cornell medicine, you heard it here. Parents, share this show with your friends and family on your social channels. We're learning from these experts together, and pediatricians are your best resource. If you have any questions about these vaccines or hesitation about masks and vaccines, please discuss it with your pediatrician and share these podcasts because it's really great information.

And Weill Cornell Medicine continues to see our patients in person, as well as through video visits. And you can be confident of the safety of your appointments at Weill Cornell Medicine. That concludes today's episode of Kids Health Cast.

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