What you need to know about children and COVID-19 vaccines

Nicole Villalpando
Austin American-Statesman

Children ages 5 to 11 can now get the COVID-19 vaccine. The CDC director and the Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices both approved the use of the Pfizer vaccine on Tuesday for this age group.

Last week the Food and Drug Administration advisory panel voted to recommend the Pfizer COVID-19 vaccine in this age group, and on Friday the FDA expanded the emergency use authorization for the Pfizer vaccine to include ages 5 to 11. 

Here's what we know about this vaccine for kids:

Vaccines:CDC panel recommends Pfizer COVID-19 vaccine for kids 5-11, shots expected to roll out this week

How effective is this COVID-19 vaccine in children?

Pfizer has said the vaccine was more than 91% effective in the children who received it during the trials this summer. Pfizer enrolled 2,268 kids ages 5-11 for this trial. Two-thirds received the vaccine, one third received a placebo. 

The antibody response rate was similar to what was seen in adults.

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Students head to class after recess at Norman-Sims Elementary School in September. Students in elementary schools around the country are closer to being able to get the COVID-19 vaccine.

What side effects can children expect from the COVID-19 vaccine?

In Austin, Austin Regional Clinic enrolled 75 kids into the trial for this age group. Dr. Jacques Benun, ARC pediatrician and lead investigator for the Pfizer COVID-19 vaccine trial at ARC, does not know which kids received the placebo and which ones received the vaccine, because it's a double-blind study. He did see were similar side effects that ARC saw with the teens enrolled in the 12 to 15 age group and the adults ARC enrolled in vaccine trials as well.

They had headaches, body aches and soreness at the vaccination site, he said.

"We didn't see anything unique from the younger or the older kids," Benun said.

With the mRNA vaccines (Pfizer and Moderna) doctors have seen some cases of myocarditis, an inflammation around the heart, in older teens and younger adults, particularly in men. After vaccination, this new age group should also watch for signs of myocarditis such as chest pain, heart palpitations or any heart symptoms.

The risk for myocarditis, Benun said, is extremely low (one or two cases per 100,000) and the adults and teens who have experienced it recover quickly without lasting damage to their hearts. The risk for suffering myocarditis from catching COVID-19 is actually higher, Benun said.

Extremely rare cases of adverse events after a vaccination are being tracked by the FDA and the CDC, and so far in the mRNA vaccines, it has been myocarditis.

Dr. Julie Boom, director of Texas Children's Hospital Immunization Project and of the Infant and Childhood Immunization for the Center for Vaccine Awareness and Research, notes that 414 million doses of the vaccine have been given in the U.S. as of Monday to people 12 and older without seeing a significant number of serious side effects.

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A syringe is filled with a dose of the Pfizer vaccine during a mass vaccination drive at Circuit of the Americas in March. Soon, kids ages 5 to 11 will be able to get vaccinated with Pfizer vaccine, but they will receive one-third the dose.

What's the difference between the vaccine for older kids and the vaccine for kids ages 5-11?

Kids ages 12 and older receive the adult dose, which is 30 micrograms. The kids ages 5 to 11 will receive one-third of the adult dose, or 10 micrograms.

In earlier dosing studies, Pfizer tested 20 micrograms and 10 micrograms for this age group and found that this age group could get the same immune response rate that adults were getting at the 10-microgram dosage. 

The kids ages 12 and older receive the adult dosing because their weight and the way their immune system responds is similar to an adult.

"As children grow, there is a difference in how children's bodies respond," Boom explains. 

Just as in people ages 12 and older, kids will be given a series of two shots at least 21 days apart initially. Just as with teens, boosters six months later have not yet been authorized.

More:Should I get a COVID-19 booster? Here's who qualifies under new FDA guidelines

Why is only the Pfizer vaccine — not Moderna or Johnson & Johnson — for children? 

Pfizer is the first company to submit its data for consideration in this age group to the FDA. Moderna is not far behind and submitted data for its trial for 6-year-olds to 11-year-olds on Monday. It had previously submitted data on trials for 12- to 17-year-olds.

Pfizer is still the only vaccine with an emergency use authorization for the 12-15 age group and approval for the 16 and older age group.

Johnson & Johnson is still in the trial phase for nonadults.

Where and when will I be able to get my children vaccinated against COVID-19?

Doctors' offices and pharmacies will be able to give the vaccine to kids. On Wednesday morning, both CVS and Walgreens had appointments available for this age group.

Austin Public Health and Travis County plan to set up vaccination sites for school districts in areas that were hard hit by COVID-19. These include Del Valle ISD, Manor ISD, Pflugerville ISD, and Title 1 schools in Austin ISD.

Make sure you put in the right age when scheduling. The vaccine for 5- to 11-year-olds will be in a different bottle with a different colored cap than the vaccines for 12 and older. The pediatric bottle has an orange cap. The 12 and older has a purple cap. Pharmacies and doctors will be instructed to give a vaccination only from the right bottle for that age group. The FDA wants to ensure that a higher dose amount is not given accidentally.

Getting out the kid vaccine:With national effort near launch, Texas leaders gearing for vaccine rollout to kids 5 to 11

Can my child get a COVID-19 vaccine and another vaccine at the same time? 

Just like with adults, these vaccines can be given with other vaccines, though it's not recommended to be in the same spot as the other vaccine. Ask your doctor for their recommendation first.

When will we be able to vaccinate infants to 4-year-olds? 

Pfizer is expected to present data on this next group of kids by the end of the year or the beginning of next year. The dosing is expected to be 3 micrograms, or one-tenth of the adult dose, about one-third of the dose for kids ages 5-11.

The good news is that newborns can get some initial protection from their mothers if their mothers are vaccinated while pregnant or if their mothers are vaccinated and breastfeeding them. 

What worries might pediatricians have about the COVID-19 vaccine?

"My biggest concern is that parents are not going to want the vaccine and will listen to the erroneous information from social media or friends who think that the vaccine isn't needed or isn't important," Boom said. 

"We want a vaccine in every child's arm to prevent serious illness and disease. Talk to your pediatrician, seek information from known resources." 

Those include the CDC, the FDA, the American Academy of Pediatrics, local pediatricians and Austin Public Health.

Students raise their hands during class at Norman-Sims Elementary School on Sept. 23. This year Austin Independent School District requires all of its students to wear masks in school.

Why is vaccinating kids against COVID-19 important?

During the surge caused by the coronavirus delta variant this summer, kids were making up about 25% of COVID-19 cases, and about 2% of kids who got COVID-19 needed to be hospitalized, Benun said.

"We have seen kids that have no underlying risk factors get very sick and end up in the hospital," he said.

Vaccination "can eliminate the risk of going to the hospital from 2% to 0%," he said. 

"Children have died from COVID-19," Boom said. According to the CDC, as of Oct. 20, 637 people ages birth to 18 have died from COVID-19. 

Even if kids don't need to be hospitalized initially, there are groups of kids who are experiencing "Long COVID," in which symptoms continue for months, or multi-inflammatory syndrome, in which weeks after their initial COVID-19 infection people start having inflammation in their organs. In the U.S. more than 5,000 cases of multi-inflammatory syndrome have been seen in children. 

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This 5-11 age group also can infect other family members who are at risk of having a severe outcome with COVID-19. "It's the ripple effect," said Brian Metzger, the medical director of infectious diseases at St. David’s HealthCare.

Getting this age group vaccinated is critical to achieving herd immunity and stopping mutations.

"All these humans under age 12 are not vaccinated, and that doesn't help us reach herd immunity," Benun said, but if we can get them vaccinated, then COVID-19 could become closer to a seasonal infection that circulates, "and life goes on," he added. 

We need to vaccinate this age group, he said, "so we can not find out what's the next variant. Do you want to get another wave in December? We're tired."

"We have the technology to make this end sooner," Benun said.

Vaccination is also the way we potentially get to not needing to mask in school or other public places, said Boom. "This is the way we're going to get school back to normal," she said.