Covid-19 Vaccination for Young Children: Is it Safe?

Schools are back in session – and with this, comes inevitable concerns about the health of our children and worries about school-related Covid-19 clusters. Many parents are still on the fence about whether or not to vaccinate their kids, despite increasing pleas for families to do so before Malaysia commences the process of transitioning to the endemic stage, beginning 1st April 2022. 

But how safe is it, really, to vaccinate our younger children? The current spike in the Omicron variant, and the approval in Malaysia of the Pfizer-BioNTech as well as Sinovac Covid-19 vaccines for those aged between 5 to 11 have certainly given parents more food for thought. From discussions with friends and family, to checking in with pediatricians, and of course, consulting dear old Google- the search has been on for answers to contribute to that final, informed decision.

To help, Dr Lim Yin Sear, Senior Lecturer at Taylor’s University School of Medicine, and Dr Noor Hafiza binti Noordin, Head of the Pediatrics Department at Hospital Banting, share useful information on the safety and efficacy of the Pfizer-BioNTech vaccine for young children, as it is still the recommended and preferred choice under the National Covid-19 Immunisation Programme for Children (PICKids).

The current status in Malaysia 

According to CovidNow, children aged 5 to 11 make up about 10 per cent of the country’s total Covid-19 cases, and it is predicted that the incidence for younger children is likely to increase further. School-related Covid-19 clusters have increased substantially in Malaysia. Most children who are infected stay asymptomatic, but they may easily transmit the virus to others, including those who are at higher risk of severe diseases. 

What the data has shown so far

As reported by CDC USA, pre-authorisation clinical trials of the Pfizer-BioNTech Covid-19 vaccine were administered to 3,109 children aged 5–11 years. Adverse effects such as pain at the injection site, headaches, and mild fever were mostly mild to moderate, and lasted only a few days. No serious adverse events were reported during these trials. 

During 3rd November to 19th December 2021, approximately 8.7 million doses of this vaccine were administered to children aged 5 to 11 years old. The Vaccine Adverse Event Reporting System (VAERS) received 4,249 reports of adverse events after vaccination in this age group, and 97.6% of which were not serious.

Since late 2021, many countries like the United States, Canada, Germany, Austria, Belgium, Hungary, Greece, Singapore, and Indonesia have started vaccination for children aged 5 to 11.

The risk of myocarditis (and pericarditis)

Myocarditis (inflation of the heart muscle) is a rare, but serious, adverse event that has been associated with mRNA-based Covid-19 vaccines. You can relax a little bit though, especially if you are a parent with younger children! To date, myocarditis among children aged 5 to 11 years appears very rare (with 11 cases in 8.7 million). Vaccine-associated myocarditis appears highest among males aged 12 to 29 years. 

Did you also know that myocarditis has actually been around way before the Covid-19 pandemic? It can occur when a virus, such as the common cold, influenza (the flu) and of course, the SARS-CoV-2 (the virus that causes Covid-19) infects the body.  Fortunately, current studies show that post-vaccine-related myocarditis is typically much milder than classic myocarditis due to the viral infection, with symptoms lasting for a shorter amount of time and usually resolving with minimal, if any, medical treatment.

Effectiveness of the vaccine 

Two recently published randomised controlled trials on the Pfizer-BioNTech vaccine for children and adolescents showed over 90% reduction in the risk of contracting Covid-19. There were no serious adverse events such as myocarditis observed, and only mild reactions such as pain at the injection site, fatigue and headache. These mild side effects are probably more likely after the second dose, so do get your kids to avoid strenuous exercise up to a week after vaccination. 

Herd immunity

Can’t we just wait for herd immunity? Traditionally, herd immunity is achieved when 80% of the population have been fully immunised against an infection. Unfortunately, with Covid-19, we will likely need more than 95% of the population fully immunised! And where are we right now? Quite a bit away, with only about 79% immunised.

Herd immunity is also a dynamic phenomenon that depends on the movement of the herd. For example, if a family has five adults and one child, and all adults are immunised, then the family is considered to have herd immunity—provided that the family lives in the same house all the time, and the child never spends any time outside.

If the child goes to school, the majority of the population are children. If all children who are not immunised congregate there, there is no herd immunity in that setting.

The ‘wait and see’ approach

If everyone takes this approach, it’s likely we will not be able to achieve the 95% immunisation rate to gain herd immunity. The danger of depending on herd immunity is if most parents decide to not immunise their children, then it’s certain that there won’t be just a few selected few who opt not to be immunised- spelling big trouble for the general level of immunity among children! With the more contagious variants like Omicron lurking around, the risk of children contracting the virus will be significantly higher. 

The importance of vaccination

The highly contagious Omicron variant being linked to milder symptoms is the result of having immunity propped up by vaccination. Imagine if vaccination amongst adults hadn’t taken place yet! Some believe we should now be treating Omicron like a normal flu, but both Dr Lim and Dr Noor would advise families not to let their guards down just yet.

Vaccination is still the most effective way to prevent Covid-19 infection and the development of serious complications, leading to the likelihood of reduced transmission in the home and in school settings, the safeguarding of friends and family who are more vulnerable, and the creation of a safer in-person learning environment.

Without effective Covid-19 vaccines for children, they could potentially become ongoing reservoirs of infection and sources of newly emerging variants. Widespread vaccination across all age groups are essential in ongoing efforts to curtail the pandemic.

In a nutshell

We hope this information helps to alleviate some of your concerns, parents.  The available data suggests that the chances of developing severe side effects from the vaccine in this age group are very rare. Children aged 5 to 11 years old are encouraged to be vaccinated against Covid-19 virus. Of course, if your child has any pre-existing medical condition, or if you are in doubt, do seek advice from your general medical practitioner or paediatrician.

Text by Dr Lim Yin Sear and Dr. Noor Hafiza binti Noordin. The contents of the original article have been edited for brevity and clarity. 

If you would like to register your 5 to 11 year old child for the Pfizer-BioNTech Covid-19 vaccine under the National Covid-19 Immunisation Programme for Children (PICKids), you can easily do so with a few  easy steps on your Mysejahtera application. Here’s to keeping our children and loved ones healthy, safe, and protected!