Thursday, May 13, 2021

Children & the COVID-19 Vaccines

Episode 60

 

Speaker 1 (00:03):
Coming to you from Beaumont, this is your house call.
Dr. Asha Shajahan (00:13):
On May 10th the Food and Drug Administration approved the first COVID 19 vaccine for ages 12 to 15 years old. This is great news because this expands the vaccine eligibility to about 87% of the total US population, which covers an additional 17 million children. And this couldn't come at a better time because one in every five people who are under the age of 18 are reported to have new infections, but many parents are skeptical and want answers about safety and they want to know, is it even necessary to get vaccinated? Don't go anywhere. The Housecall Podcast is going to address your concerns and the COVID 19 vaccine and children. Hello, and welcome to the Beaumont Housecall Podcast. I'm Dr. Asha Shajahan.
Dr. Asha Shajahan (01:12):
We're here to help you and your families live smarter and healthier lives. Today, we're going to talk about children, age 12 and older, who are now eligible to get the COVID 19 vaccine. Should they get it? What do you need to know? We have Dr. Bishara Freij, a pediatric infectious disease specialist at Beaumont Hospital in Royal Oak joining us today. Dr. Freij. Thanks so much for being here with us.
Dr. Bishara Freij (01:38):
My pleasure.
Dr. Asha Shajahan (01:39):
So, Dr. Freij, this is a game changer. Pfizer has now approved their vaccine for 12 years and older, and it looks like about 20% of the COVID cases that are positive are within this age group. How do you think this is going to impact the numbers now of positive cases?
Dr. Bishara Freij (01:57):
So, this one will have a variety of impacts, all positive, I would say. So, first of all this age group you are describing the 12 to 15 accounts for the percentage you cited, but also represents quite a few of the kids that we have seen admitted with severe pneumonia in the past several weeks, during the most recent surge in Michigan. And so we've seen a lot of really ill patients with the protracted illnesses and preventing disease in that age group is very valuable for them. And that's one thing. And two those who don't develop bad disease, they have either asymptomatic infection or mild infection, will not go ahead and spread this to other people around them, whether within the family unit or friends at school or on any sports team they may be on. So it's very important.
Dr. Asha Shajahan (02:59):
Yeah, so I think a lot of parents think in general that COVID-19 doesn't affect children and it sounds like it does.
Dr. Bishara Freij (03:09):
So, first of all, that's a major misconception, unfortunately, what is known about it is that the children, weather the infection better than adults, that they are a little less likely to develop severe disease and that the quote, the numbers, are less than adults. Now, I want to qualify the numbers issue because, and this is people don't remember the beginnings of this pandemic. So, if we look back into last spring, we were not able to test children because there was a shortage of reagents to do the testing. So, and in fact, even adults had to be like really sick before a test is approved to be done on them because there was just such a limited supply of product out there. So all the numbers that people cite that children didn't account for many kids, many patients in the past, you have to think that in the context of how testing was done. Right now, testing is done basically if you want to do it yourself, you can go and get it done at the urgent care, there are some kits you can do with at home.
Dr. Bishara Freij (04:25):
I mean, testing is all over the place. In my practice of infectious disease, whenever I evaluate kids, who've had a prolonged fever or recurrent fever, which is a common problem that I face in my office. The almost everybody has three, four, five COVID tests done before I even see them once. So, testing is widely available, and as a result, you pick up more numbers. The other thing is even if the percentage of kids that get really sick is small, when you're talking about millions and millions of people, this is still a large number of people getting really sick. And our wards and our ICU have had their share of patients with very severe illnesses who were previously healthy. You would not have necessarily predicted that they would struggle with this virus, but they do. And so it's a misconception that they can't get sick or that my son or daughter are very healthy and they are not the ones who are going to get ill. The majority of kids I've taken care of were previously healthy and got very ill. And in addition to some that are high risk.
Dr. Asha Shajahan (05:42):
Yeah. So it sounds like the reporting might've been under-reporting in the past and so that there is not necessarily more cases of children than there might've been in the beginning. And from what you're saying, it is still a big risk for our children not only that they could get severe disease or get disease or that they could spread it to others as well.
Dr. Bishara Freij (06:02):
So, one of the big problems we are facing with this virus is the fact that there is still a big chunk of the population that is unimmunized. These are the ones who already qualify for a vaccine and have chosen not to do it, or are still on the fence about getting it. So this virus mutates a lot, and this is what happens with these RNA viruses. And if it mutates, it can mutate into milder versions of the virus or more severe versions of the virus. And what happens is if you don't prevent infection, you don't prevent replication, if you don't prevent replication, you can't prevent the emergence of variants. And some of these variants are going to be resistant to the antibodies generated by vaccines. So it is incumbent on everybody to try to halt multiplication of the virus. So the virus doesn't care if I'm too sick or not sick, if it's replicating and plugging along and moving along from one human to the next, it's fine with the virus, but it's not good for everybody.
Dr. Asha Shajahan (07:11):
Yeah. So I think it's really important that we really start considering vaccination. So for parents that are listening, can we talk a little bit about the safety of vaccinating this age group? And can you maybe go over the trials and what was looked at, and for people that are concerned about safety, what can you tell parents about the safety of the vaccination?
Dr. Bishara Freij (07:33):
The study that was the basis for the FDA clearing the vaccine for this age group was done in about over 2200 teenagers, between 12 and 15. And what they did was they randomized them into the kids who got the actual vaccine, the Pfizer vaccine and others who got the placebo, which is a saline injection. And they compared the two groups in terms of side effects and then development of any COVID infection. And what they found was that among those who got the actual vaccine, none of them developed a COVID infection. And among those that got the placebo, there were about 18 cases of infection. So there was clearly a big difference between those who got the vaccine and those who didn't. So the ones who got it were totally protected from the compared to those who got the placebo. In addition, what they did was, of course, they looked at side effects and they compared the side effects of those who got the vaccine to a previous group that was tested, which was the 16 to 25 year olds. And they looked at the frequency of pain, arm pain, fever, fatigue, headache, you know.
PART 1 OF 4 ENDS [00:09:04]
Dr. Bishara Freij (09:03):
... arm pain, fever, fatigue, headache, all these various adverse effects. And they found them to be very comparable to the older age group. It's essentially no difference in the frequency of side effects. And then, they also looked at just around the 200 kids in that group and looked at their immune responses, how well they responded to the vaccine, not just that they didn't get infected, but what kind of an antibody response did they generate?
Dr. Bishara Freij (09:34):
And what they found is they generated antibody responses that were actually quite a bit higher than what the 16 to 25-year-old age group generated. So, they not only did not get disease, they had higher antibody levels and their side effect profile was totally similar to the previously studied slightly older age group.
Dr. Asha Shajahan (09:58):
Yeah, that sounds great. It sounds like they're building greater immunity or responding well to the vaccine, and then the side effect profile is similar. Can we just remind people what some of those side effects would be expected for this age group?
Dr. Bishara Freij (10:12):
The most common side effect that's reported is injection site pain. And having had the vaccine myself, I can tell you it's real. And that's described in about 80 to 85% of people who get the vaccine, but that lasts for a couple of days and goes away. And then, there are other complaints like headache and fatigue, a small percentage, maybe 15, 20% may have some fever.
Dr. Bishara Freij (10:43):
The side effects tend to be more after the second shot than the first shot, but they are all transient. And for some people, it may be uncomfortable, but for the majority of people, it's more of a nuisance than an actual ... it doesn't prevent them from functioning and doing their schoolwork or jobs or whatever it is they're engaged in.
Dr. Asha Shajahan (11:08):
Yeah, you might notice some mild symptoms.
Dr. Bishara Freij (11:10):
They are mild symptoms, and a lot of them, you get a Tylenol or Motrin here and there, and it's sufficient to keep you going. And they're all brief. The bottom line is all they're transient, not a big deal and people tolerate it quite well.
Dr. Asha Shajahan (11:25):
Yeah, and so, when you say transient, it usually means about 24 to 48 hours maximum. You might feel a little fatigue, might have some soreness in your arm, but other than that, you should probably be able to do your everyday activities. If parents are concerned about their children, it's probably going to be the same as when you have the vaccine. So, that's pretty reassuring.
Dr. Bishara Freij (11:45):
Can I make one other point about this?
Dr. Asha Shajahan (11:47):
Sure.
Dr. Bishara Freij (11:47):
These side effects are comparable to other vaccines that people get. If you get the flu vaccine, the rates of these side effects are in the same ballpark. So, it's not like worse than a flu vaccine. And certainly, for those who will get the tetanus boosters, the local pain is much more intense. So, these are not outlier side effects. They're actually very commonly described in all the other routine vaccinations that people get as recommended.
Dr. Asha Shajahan (12:20):
Yeah, and I think our kids are used to getting vaccinations more than adults are. So, I think that they're pretty robust and they bounce back pretty quick. When we're looking at some of the other trials that are underway, for example, this one was done for age 12 and older. Why are these studies broken into different groups by age? Why is it that they're picking 12 and older, and then are they going to do ones for earlier, maybe five years or even below that? How do they decide between the age ranges? And then, what do you also know about other trials that are underway for younger age groups?
Dr. Bishara Freij (12:55):
The children are not all the same in terms of their immunologic responsiveness. The 12 to 15-year-old generally are comparable to older adolescents. So, it's easier to use the same formulation that was done in adults, which is what they studied and evaluate that. Once you start getting younger, you start having to look at different vaccine doses. For example, some of the studies being done in the younger kids, which are ongoing down to six months of age right now, they are looking at three different dosage regimens, meaning the amount of RNA and the product is not the same as adults.
Dr. Bishara Freij (13:40):
So, they're giving a quarter of the dose, half the dose and the full dose in three different groups and comparing side effects, immune response. They're trying to see what dose does a child really need depending on their age. And this is, again, not something strange because there are vaccines that the dosing is different depending on the age of the vaccinated person.
Dr. Bishara Freij (14:06):
The reason for breaking it down in this manner is because, basically, you don't want to mix the six month old with the 10-year-old because they're not exactly the same type of human. Their immune systems are at different stages. So, they break it down into more homogeneous type of children. And so, that's why the five to 12, and that's actually, right now, a big percentage of the pediatric cases out in this age group, especially that MISC disease that we worry about, the post-COVID immune activation. I think they're just trying to do it in a systematic way and try to roll this through without mixing kids who are not necessarily similar.
Dr. Asha Shajahan (15:02):
Yeah. And so, when people are thinking about the severity of disease, and you mentioned MISC, if you could briefly talk about what that entails? I just want to talk about the fact that there's a lot of parents that are worried about the long-term side effects of getting the vaccination, but I wanted to also emphasize some of the long-term side effects of actually getting COVID. Is there a way that you can just compare the two in terms of, one, are there long- term side effects to getting the vaccine, and then two, what are the long-term side effects of getting COVID?
Dr. Bishara Freij (15:38):
COVID infection can take many different paths in anybody. You can have the asymptomatic infection, the mild disease, the severe pneumonia and clotting in the lung. We, right now, have somebody in our ICU who had COVID a couple of weeks ago diagnosed, and now has a lot of clots in the lungs and infarcted lungs, previously healthy, just overweight child.
Dr. Bishara Freij (16:07):
And then, you have what is called post-COVID, the immune activation, which is that multi-system inflammatory syndrome in children. And this one is actually an overactive immune response to the virus, but the disease attacks many organs such as skin, eyes, et cetera, but its main target is the heart. And these kids have bad heart inflammation, coronary artery abnormalities, and they are very sick children who need a lot of aggressive immune-modulating medications, such as steroids, gamma globulin, infliximab. We work very hard on them. We've been very successful at reversing it, but the children are sick for several days and typically in the ICU. Now, post-COVID, if you recover, the long-term studies are only happening now because COVID has not been with us endlessly. It's a relatively new disease. So, all the long-term issues, it will take a while to manifest themselves. We're seeing, in the short-term, a lot of mental health problems, especially in adolescents, associated with all the restrictions that have come from COVID being around and not being able to attend school or do their normal activities.
Dr. Bishara Freij (17:35):
There have been an increase in suicide attempts and admissions for suicide and depression. We've seen that here. The CDC has already published this. They monitor things around the country, but it's reflected locally as well. So, a lot of mental health problems. And then, over time, people are beginning to look at long-term illnesses. There was a recent study that looked at what's called a new diagnosis with-
PART 2 OF 4 ENDS [00:18:04]
Dr. Bishara Freij (18:03):
There was a recent study that looked at the what's called the new diagnosis with a year of having COVID, and they found like about 80 or so percent of people have had a new diagnosis made in them.
Dr. Asha Shajahan (18:12):
And a new diagnosis meaning a new diagnosis of a chronic illness, or what do you mean by a new diagnosis?
Dr. Bishara Freij (18:17):
So something of a chronic nature. It varies, it can be psychiatric, it can be organic, but there's something new that they didn't deal with before. How long this would last? We don't know. Is this something that's going to be there for like a year and then go away, or is this going to be a bigger problem? We don't know any of this.
Dr. Asha Shajahan (18:39):
But either way it sounds like getting COVID 19 is very dangerous for our children with having the possibility of getting the multi-system inflammatory syndrome. And then all of these side effects that you're talking about in terms of having gaining a chronic illness, or having suicidality or mental illness, these are things that we do not want our kids to have.
Dr. Bishara Freij (19:02):
Absolutely.
Dr. Asha Shajahan (19:03):
I think that we are fortunate that there is a vaccine available that can help prevent this. And then from what you're telling me Dr. Freij is the studies look amazing in terms of the effectiveness of the vaccine on children.
Dr. Bishara Freij (19:16):
The COVID vaccine is the first MRNA vaccine. So the Pfizer and Moderna vaccines are MRNA based vaccines. They are the first to be approved for use formally. I know they don't have full approval for use, it's all the emergency use authorization at the moment, but this is going to change. The companies I've already submitted the paperwork to get full authorization, meaning it's not the emergency use anymore.
Dr. Bishara Freij (19:47):
Although these vaccines are new, the technology is not new. There have been MRNA vaccines around for a very long time, at least a decade and longer. There are a lot of studies with other RNA viruses like Ebola and others where they've tried out these MRNA vaccines. There are a lot of animal studies looking at safety, looking at effectiveness, and some long-term issues with the vaccine. So they're not like somebody just thought about them last year and now they're on the market. They have a basis of a whole slew of...
Dr. Asha Shajahan (20:27):
Decades of research.
Dr. Bishara Freij (20:29):
Of studies and research behind them. And that's why actually they could be rolled out so fast because that technology existed. It was just this is this imperative of the pandemic that led everybody to focus on trying to get something out quickly.
Dr. Asha Shajahan (20:44):
So Dr. Freij, what do you think about the changing guidelines of the CDC? Many parents are concerned that they look to the CDC for information, but sometimes it's confusing because the guidelines seem to change, and change often. What are your thoughts on that?
Dr. Bishara Freij (21:01):
What I say to that is they should be happy that the CDC revises their recommendations based on the best available new evidence that they have. This is new to everybody. So the studies are going on and we're in the midst of the pandemic. And they are working very hard to collect the best information from around the country, and actually around the globe as well, and modify the recommendations based on conditions on the ground.
Dr. Bishara Freij (21:38):
So when we drive a car, we don't go one speed and one direction. We go fast, we slow down, we change lanes, we turn right, we turn left, so it's not as simple as just do this for this long and it's over there. The virus is changing. We have different types of people, some of whom are all for vaccination, some are hesitant, some are totally anti-vaccination, new variants emerging.
Dr. Bishara Freij (22:07):
So you should want an agency that looks at everything constantly and adjust things to fit the current understanding, new information, what makes more sense today, and next week is another, it may be changed a little bit. So people should not look at this as they don't know what they're doing, they should look at this as they know what they're doing very well and adjusting as more and more information accumulates, and new data emerge, and new trends emerge. So just it's a plea to whoever is listening to this podcast not to take it as a negative, but take it as a very positive behavior by the CDC and the FDA.
Dr. Asha Shajahan (23:01):
Yeah. I love that analogy of the car because the fact that we're driving towards the destination of getting to a COVID free world, and we may have to break, we may have to speed up like you said, we may have to change lanes or change directions, but our hope is that we all have the same destination in mind, and that's to get to a COVID free world, and the way that we can do that is through vaccination.
Dr. Asha Shajahan (23:25):
So if kids are starting to get vaccinated, what are some things that they can start doing now? Can they start playing sports? And would they be able to go back to in live school? There is some benefits to getting vaccinated other than just the COVID-19 and not getting sick. What are some of those social benefits?
Dr. Bishara Freij (23:42):
So once somebody is vaccinated, and we know the kids will respond well to the vaccine, the vast majority will as detailed in the studies, and these kids once they are vaccinated... So if you are vaccinated, you are less likely to get infected. If you do get infected, that's so-called breakthrough infection, these are uncommon, really uncommon, and you don't really get sick either. And if you're not symptomatic, you're also much less likely to spread it to somebody else.
Dr. Bishara Freij (24:14):
So even if I get a breakthrough infection and it's mild, the chance that I would spread it to somebody else is very, very small. So it's a net winner, and it allows people to congregate and do the things they want. So for example, the summer is coming. There are people who want to go to camps. There are people who want to do summer sports. There are people who want to hang out with their friends. And all of these things are things we all enjoy doing, and I think the vaccine allows us to do that, and get back to that much, much faster than otherwise.
Dr. Asha Shajahan (24:54):
Yeah. And I think our kids have been working really hard this past year to just try to be as normal as possible. And it's been really hard not being able to socialize, see grandparents, hang out with their friends, and I think this is great news. In my practice I have lots of children that are like, "I want to get this vaccine." They're so excited about it because they know that if they're vaccinated, and their friends are vaccinated, they can now spend time together, and they can hug their grandparents again, and they can really just be part of what life was like before.
Dr. Asha Shajahan (25:26):
And so I think that is just amazing and great, and we're really fortunate for the technology. And as you mentioned, it's not new technology, and I think a lot of people are hesitant and scared because of the fact that it's your children, and you want the best for your children. But I think when you think about the odds of what is severe disease, and what this pandemic is doing to all of us, not only mentally but physically, vaccination sounds like the best route to protect your child. So I just, I'm excited about it.
Dr. Bishara Freij (25:59):
Yes. And not just protect the child, but protect even the vaccinated people who against the emergence of new variants that may evolve in children and the adults who are not vaccinated, because that has the potential to derail a lot of things. So the sooner we vaccinate as many people as we can, at least certainly the ones in which it's been studied and shown to be safe and try to plug all these gaps in immunization, the sooner we can put a lid on this thing and try to get back to some kind of normalcy.
Dr. Asha Shajahan (26:39):
Absolutely. And so any tips for parents when they're taking their child for vaccination? Anything that they should be prepared for ahead of time, when they're about to go get their vaccine, any special tips?
PART 3 OF 4 ENDS [00:27:04]
Dr. Bishara Freij (27:03):
There's nothing unique. And if a parent has had the shots themselves, they can tell them, "Oh, I had the same thing and I was fine. And it's just going to be a little bit..." And just sort of reassurance. Most of the kids, the trouble they have with he vaccination is the anticipation of an injection. It's not so much... Like once they get it, a lot of them are done and they're snap out of it because it's over. So it's all about reassurance and being there for them, and with them, and they'll take it. They take it better than adults in the end.
Dr. Asha Shajahan (27:39):
Yeah. I would recommend being very hydrated well. Make sure you drink plenty of fluids beforehand and avoid any Tylenol or Motrin before the vaccine because you don't want to inhibit the immune response. And then, just like Dr. Freij said, it's important to just sort of prep them that, "Hey, you might have some side effects and that's okay. You'll be better in one or two days. And then you'll be good to go after you get your full immunity."
Dr. Asha Shajahan (28:07):
So again, there's a false notion that as soon as you get your vaccine you're completely immunized, but you have to wait for at least that two week period, and then if after you get both doses as well before you're considered to be fully immunized. So just keep that in mind. And I think just prepping our children and knowing that, I think it'll help make it a smoother process.
Dr. Asha Shajahan (28:31):
So what would you say to parents who are still maybe a little bit hesitant about getting the vaccine for either themselves or their children?
Dr. Bishara Freij (28:43):
So what I would say is I lead by example. I took the vaccine as soon as it became available to me. My son has gotten the vaccine. My mother's gotten the vaccine. Everybody in my family has gotten the vaccine, and anybody who's ever asked me about the vaccine I'd say, "Go get it." No hesitation. So I can only lead by example. So clearly, I care about my family as much as anybody else cares about their family, and the best thing was for them to get vaccinated, and they have. And they've done very well fortunately.
Dr. Bishara Freij (29:20):
So I think nobody forced me to take the vaccine. It was just made available to me because I work in healthcare, and I was more than happy to be one of the earliest people that could have gotten it. So if I told you to go get it but I haven't had it myself, it's a...
Dr. Asha Shajahan (29:43):
A different story.
Dr. Bishara Freij (29:45):
Different story. This virus does not distinguish between ethnic background, socioeconomic status, et cetera. In fact anybody. Some people because of health inequities are at higher risk of problems and complications but it'll infect anybody. So all it needs is a susceptible host. We all carry the receptors for the virus and we have to just interrupt its transmission. And the vaccines, vaccines, vaccines, this is our ticket out.
Dr. Asha Shajahan (30:23):
Yeah. So I think just the more you read, the more you're empowered. If you have questions, ask your pediatrician about questions about the vaccine, and then once you feel comfortable then you can go ahead and get your child vaccinated. But I say ask as many questions as you need to feel comfortable. And the research is out there, and it's promising, and so I think we're looking in good shape for our children to be back in school, and back to the activities that they love.
Dr. Asha Shajahan (30:54):
Well, that's all we have time for today. Thank you so much Dr. Freij for joining us and reviewing some of the guidelines of the current vaccine for children. And we're looking forward to maybe more vaccines being approved for children in this age group.
Dr. Bishara Freij (31:10):
It will come. I have no doubt that it will happen.
Dr. Asha Shajahan (31:14):
Thanks so much for joining us.
Dr. Bishara Freij (31:15):
My pleasure.
Dr. Asha Shajahan (31:17):
All right podcast listeners, make sure you subscribe to our podcast to hear some of the latest information on COVID-19 and vaccines. We have several podcasts that are out now on the various vaccines, and then also several on COVID-19 to help you stay informed.
Dr. Asha Shajahan (31:34):
We leave you today with this healthy thought. If you're a parent who wants to protect your child, read up and get the facts, talk to your pediatrician, ask questions. Vaccines are a crucial way to end this pandemic. The Pfizer vaccine is safe and is recommended for children over the age of 12 by pediatricians. Everyone has had a tough time with this pandemic, especially our kids. By getting vaccinated our kids have a chance to return to the activities they so missed and loved.
Speaker 2 (32:16):
Continue your journey to living a smarter, healthier life. Visit beaumont.org/podcast to access information and resources related to today's podcast.
PART 4 OF 4 ENDS [00:32:29]

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