COVID-19 Vaccine In Children

From the Desk of the 
Medical Director
Rajiv Gandhi Cancer Institute & Research Centre, Niti Bagh
Dr. Gauri Kapoor, MD, PhD

India – statistics for children

With a population of 1.3 billion, India has one of the largest numbers of children in the world.  Nearly one quarter of our population is in the age group 0-14 years and they account about 500 million children in this age group.

In India, 17% of all deaths in children <5 years old are due to pneumonia. Most studies have implicated RSV as the most common and consistent virus associated with LRTI in Indian children. Other viruses that have been implicated for respiratory viral infections in children are Influenza, parainfluenza, rhinovirus, adenovirus, enterovirus, EBV, human corona virus (SARS-CoV-2).

How common is corona virus infection in children?

In the past, it was rare to have children with corona virus induced pneumonia as most viral pneumonias were treated with supportive care measures, without etiological agent being tested. However in the last year, with onset of pandemic, there has been a rise in cases of SARS-CoV-2, which appears to have affected adults more than the pediatric population.

Children of all ages are at risk for SARS-CoV-2 infection.The true incidence of SARS-CoV-2 infection in children is not known because most of the testing has been prioritised for adults and those with severe illness. Some studies show that children and adolescents tend to have milder disease compared to adults.

The age distribution for COVID infection in India (ICMR) shows that children are less affected than adults (Figure 1). However,  at-least 50 per cent of the children surveyed during the fifth round of serological surveillance in Delhi were found to have antibodies against Covid-19, indicating that children do have equal exposure and an adequate number of antibodies levels when compared to adults.

How does COVID manifest in children? Any different from adults?

Most patients, including children may be asymptomatic carriers, and detected to be COVID positive on mere contact screening.

The most commonly reported clinical manifestations are: fever only, respiratory symptoms only (cough and coryza), or combined (fever and respiratory symptoms).

Other manifestations reported in current studies are gastrointestinal symptoms like diarrhea and vomiting, which are more common in children than adults.

Rarely, children may present with manifestations of hyper inflammatory states and / or Kawasaki-like disease and may pose a diagnostic challenge, thus high index of clinical suspicion is required.

Do children need to be vaccinated?

As per WHO (April 2021): There is not yet enough evidence on the use of vaccines against COVID-19 in children to make recommendations for children to be vaccinated against COVID-19.In light of the safety and immunogenicity results from recent adult COVID-19 vaccine clinical trials, children should have the opportunity to be included in clinical trials in parallel to ongoing adult phase 3 clinical trials in a manner that is careful, methodical and transparent. There is already data from certain vaccines that the vaccine is safe in the 12-18 year ages.

How would children benefit from vaccination?

Children could benefit both directly and indirectly from vaccination.

Children are also susceptible to downstream effects of COVID-19, including social isolation and interruption in education. Developing a paediatric COVID-19 vaccine could prevent disease, mitigate downstream effects and enable children to re-engage in their world. It will help alleviate the concerns of parents and teachers alike regarding the spread of infection within schools. It is more preferable than mass testing and mitigation measures in the longer term. Moreover, if we really want to get back to normalcy, we really need to achieve herd immunity across all the groups including children.

Is there an age cut off for COVID vaccination in children?

Three vaccines have received emergency use authorization for adults, and one can also be given to teens age 12 and older.  C​linical trials are now underway in children as young as six months old.

Various vaccine manufacturing companies (India and western world) plan eventually to enroll children under five who might still be due to receive boosters of polio vaccines and jabs against measles, mumps and rubella, as well as other immunizations, but children will need to be up to date on their vaccination schedules to participate. Studies of how a COVID-19 vaccine should best be integrated into a child’s immunization schedule will need to come later, once a safe and effective vaccine is found.

How can we keep our children safe?

It is quite likely that vaccines with demonstrated safety and transmission efficacy data in children will not be available anytime soon, so what can we do to keep our children safe?

1. Awareness of disease, its symptoms and prompt medical consultation if symptoms of COVID occur, leads to early intervention and low morbidity and mortality.
2. Routine measures of wearing mask, social distancing and hand washing remain mainstay of preventive measures.
3. Ensure complete vaccination of all adults in the family and at school.
4. Let’s make sure we continue vaccinating healthy and vulnerable children according to Nationally recommended schedules to protect them and avoid other epidemics in the future-with vaccine-preventable diseases like measles, mumps, hepatitis etc.
5. Due to community mitigation measures and school closures, transmission of SARS-CoV-2 to and among children may have been reduced.
6. Home isolation for those affected from those who are not, is the key for management of those with asymptomatic disease or with mild symptoms.

What are the side effects of COVID vaccine?

The vaccine has side effects profile similar to most other flu vaccines. The most common side effects following COVID-19 vaccines are fatigue, fever, headaches, body aches, chills, nausea, diarrhea, and pain at the site of injection, according to the World Health Organization.

Research shows the vaccines are remarkably effective and safe. The American Academy of Pediatrics (AAP) urges​ children and adults to get the COVID-19 vaccine as soon as it is available to them. This is especially important with a rise in cases caused by variant strains of the virus, which seem to be more contagious

Life threatening events are very rarely reported, and so far none of the trials have reported any mortality due to COVID vaccine in pediatric trials.

Dr. Gauri Kapoor MD, PhD
Medical Director – RGCIRC, Niti Bagh &
Director, Department of Pediatric Hematology Oncology

Dr. Payal Malhotra
Attending Consultant – Pediatric Hematology Oncology