Stay Up-to-Date on COVID-19 Vaccines for Children, Teens

With the COVID-19 pandemic now in its third year, it is important that children and teens stay up-to-date on their vaccinations, and pharmacists can help familiarize them and their parents with the different vaccines and learn which are appropriate for pediatric use.

Children and teens can get the virus that causes COVID-19, but their symptoms tend to be milder than those of adults or there may be no symptoms.¹ As with all illnesses, COVID- 19 may be more serious in children and teens with certain underlying medical conditions, such as asthma, diabetes, heart disease, immunocompromised status, or obesity.²

Fewer COVID-19 hospitalizations have occurred among individuals in the United States younger than 19 years, compared with adults. Research findings show that more than 90% of children who get sick have mild to moderate symptoms including cough, diarrhea, fever, runny nose, and vomiting.¹

Children and teens have been hospitalized with a condition called multisystem inflammatory syndrome in children (MIS-C), also known as pediatric multisystem inflammatory syndrome. Doctors suspect these cases may be linked to COVID-19. Most children with COVID- 19 experience only mild illness, but in those who develop MIS-C, organs and tissues such as the blood vessels, brain, digestive system, eyes, heart, kidneys, or skin become severely inflamed.³ Signs and symptoms depend on which areas of the body are affected but can include confusion, diarrhea, headaches, fever, stomach pain, rash, trouble waking up, and vomiting.¹

The CDC recommends that children 6 months and older receive the COVID-19 vaccine. It also recommends that children 5 years or older receive a booster dose.⁴

Three manufacturers have produced COVID-19 vaccines, and 2 of these are indicated for use in children. The Janssen/Johnson & Johnson vaccine is not indicated for pediatric use, whereas the Moderna and Pfizer-BioNTech brands are. Keep in mind that though it is best practice to stay up-to-date on all vaccines, COVID- 19 vaccines do not provide 100% immunity, nor does natural immunity from having had the virus. Booster vaccines are necessary and may become an ongoing recommendation similar to the influenza vaccine.

Pfizer-BioNTech

Primary Series: Indicated for children 5 years and older and consisting of 2 doses of Pfizer-BioNTech, this series is given 3 to 8 weeks apart. Patients younger than age 18 years who are moderately or severely immunocompromised should get a booster at least 4 weeks after the second dose in the primary series.⁵

The vaccine is also indicated for patients aged 6 months to 4 years and consists of 3 doses of Pfizer-BioNTech in the primary series. The first and second doses are separated by 3 to 8 weeks, and the second and third doses are separated by at least 8 weeks. For patients under 18 who are moderately or severely immunocompromised, the first and second doses are separated by 3 weeks, and the second and third doses are separated by at least 8 weeks.⁵

Boosters: Children who received a Pfizer-BioNTech primary series should get a booster, and these are indicated for patients 5 years and older. Patients aged 6 months to 4 years should not receive boosters.⁵

Moderna

Primary Series: Indicated for patients aged 6 months to 17 years, this series consists of 2 doses of Moderna. The first and second doses are separated by 4 to 8 weeks. Patients under age 18 years who are moderately or severely immunocompromised should get a third dose, with the first and second doses separated by 4 weeks, and the second and third doses separated by at least 4 weeks.⁶

Boosters: A booster dose is not authorized for children and teens in this age group who received a Moderna primary series.⁶

Safety

COVID-19 vaccines undergo the most intensive safety monitoring in US history. Evidence from the hundreds of millions of COVID-19 vaccines already administered in the United States and the billions administered globally shows that they are effective and safe.^5,6 Adverse effects (AEs) usually occur within 7 days of being vaccinated. These are common and mostly mild, although some individuals have reactions that affect their daily activities. Some AEs occur throughout the body— chills, fever, headache, and fatigue—and are more common after the second dose.^5,6

There is a rare risk of myocarditis and pericarditis with COVID-19 vaccination, typically occurring in males aged 12 to 39 years. This risk may be reduced with a longer interval between the first and second doses.^5,6

Interchangeability

In general, the same vaccine product should be used for all doses in the primary series. In exceptional situations in which the vaccine product administered for a previous dose or doses of the primary series cannot be determined or is not available, any age-appropriate COVID-19 vaccine product may be administered at a minimum interval of 28 days between doses to complete the COVID-19 primary vaccination series.⁷

Children aged 6 months to 4 years who receive different products for the first 2 doses of a COVID-19 vaccine series should follow a 3-dose schedule. A third dose of either vaccine should be administered at least 8 weeks after the second dose.⁷

About The Author

Kathleen Kenny, PharmD, RPh, has more than 25 years of experience as a community pharmacist. She is a freelance clinical medical writer based in Homosassa, Florida.

References

1. COVID in babies and kids: symptoms and prevention. Johns Hopkins Medicine. Updated June 22, 2022. Accessed July 12, 2022. https://www.hopkinsmedicine. org/health/conditions-and-diseases/coronavirus/ coronavirus-in-babies-and-children#:~:text=Fever%20 and%20cough%20are%20common,throat%2C%20 excessive%20fatigue%20or%20diarrhea.

2. Choi JH, Choi SH, Yun KW. Risk factors for severe COVID-19 in children: a systematic review and meta-analysis. J Korean Med Sci. 2022;37(5):e35. doi:10.3346/ jkms.2022.37.e35

3. Multisystem inflammatory syndrome in children (MIS-C) and COVID-19. Mayo Clinic. November 12, 2021. Accessed July 12, 2022. https://www.mayoclinic.org/diseases-conditions/mis-c-in-kids-covid-19/symptoms-causes/syc-20502550

4. COVID-19 vaccine recommendations for children and teens. CDC. Updated June 24, 2022. Accessed July 12, 2022. https://www.cdc.gov/coronavirus/2019-ncov/vaccines/vaccines-children-teens.html

5. Pfizer-BioNTech COVID-19 vaccine (also known as COMIRNATY): overview and safety. CDC. Updated July 14, 2022. Accessed July 12, 2022. https://www.cdc.gov/coronavirus/2019-ncov/vaccines/different-vaccines/ Pfizer-BioNTech.html

6. Moderna COVID-19 vaccine (also known as Spikevax): overview and safety. CDC. Updated July 14, 2022. Accessed July 12, 2022. https://www.cdc.gov/ coronavirus/2019-ncov/vaccines/different-vaccines/Moderna.html

7. Interim clinical considerations for use of COVID-19 vaccines currently approved or authorized in the United States. CDC. Updated June 20, 2022. Accessed July 12, 2022. https://www.cdc.gov/vaccines/covid-19/clinical-considerations/interim-considerations-us. html#timing-spacing-interchangeability