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N.C. pediatricians gear up for giving COVID-19 shots to infants, toddlers


Christoph Diasio, a Southern Pines pediatrician and president of the North Carolina Pediatric Society, was thrilled on Tuesday as COVID-19 vaccines for children as young as 6 months old were being distributed across the state.

The Centers for Disease Control and Prevention opened the door for such distribution on June 18 when the federal agency endorsed a recommendation from its Advisory Committee on Immunization Practices that access to COVID vaccines be expanded to include children from 6 months to 5 years old.

That has led to a pounding on pediatricians' doors by some parents and caregivers who have waited anxiously to have their young ones protected from a virus that has wreaked havoc on the world for nearly two and a half years. Other parents are taking a wait-and-see approach or not planning to get their children vaccinated at all.

"We are thrilled and excited," Diasio said of pediatricians gearing up to vaccinate children in their offices and clinics. "This is better than Christmas and Hanukkah, and all other religious holidays, all wrapped up together. This is an answered prayer. We have been waiting for this a long time."   

On June 17, a day before the CDC issued its recommendation, the Food and Drug Administration authorized emergency use of the Moderna and Pfizer vaccines for children as young as 6 months old.

The Moderna vaccine is administered in two doses for children.  Pfizer developed a three-dose vaccine for children younger than 5 after the company realized that a two-dose vaccine they were developing failed to produce a sufficient level of antibodies or protect children as the Omicron variant began to spread.

Ready for that shot

Kreth Ball-Johnson, the mother of a 3-year-old and a child not yet 6 months old in Raleigh, has been eagerly awaiting the news. Her older child got COVID in February.

"He had a fever for maybe three days, then he seemed much better," Ball-Johnson said.

Ball-Johnson said she had no qualms about getting her 3-year-old vaccinated and plans to get her younger child vaccinated when she can. Her family has curbed their activity during the pandemic and she is ready to do more without having to worry about them getting sick. She plans to go to her pediatrician when she can get an appointment.

For those who are not as enthusiastic as Ball-Johnson about getting their children inoculated, Diasio tries to reason with them. COVID, he explains, "is a top-five killer of children in America."

Across the country, 1,235 children under the age of 15 have died from COVID-19 infections and 485 of those deaths were children younger than 4 years old, according to the CDC.

"We usually think children matter in America and we need to hold on to that," Diasio said.

Though his youngest child is 17, Diasio said, if he had children newly eligible for a COVID vaccine, he wouldn't hesitate.

"We know enough now to say it's safe and effective," Diasio added. "Waiting any longer to be protected against what's been a bad disease doesn't sound like a good plan to me."

Lingering hesitancy

The percentage of children younger than 18 who are eligible to be vaccinated who have received their shots has not topped 50 percent, according to the state Department of Health and Human Services COVID vaccine dashboard. Among those who are from 12 to 17 years old, 384,911 children, or 48%, have had at least one dose. Only 27% of children ages 5 to 11, or 241,501 in all, have had at least one vaccine dose. 

Children aren’t considered fully immunized until they’ve had that second or third dose, however.

A Kaiser Family Foundation COVID-19 Vaccine Monitor showed that national polling from April found that only 18% of the parents contacted planned to get their children younger than 5 vaccinated right away. Thirty-eight percent said they would take a "wait-and-see" approach. Eleven percent would get their young children inoculated only if required to do so for school, according to the poll, and 27% definitely would not vaccinate their child.

“Many parents and families have been eagerly awaiting a vaccine to protect our youngest North Carolinians,” Kody Kinsley, secretary of the state Department of Health and Human Services, said after the CDC announcement. “These vaccines are the best way to protect children from COVID-19 — they are safe, effective and free.” 

Many parents and caregivers have questions. The NC Health News team has some answers.

Do you really need to get your child vaccinated if you or they have had COVID?

The CDC recommends the COVID-19 vaccine for everyone 6 months and older. The dosage and number of doses in the COVID-19 vaccine series varies based on the child’s age

“Emerging evidence indicates that people can get added protection by getting vaccinated after they have been infected with the virus that causes COVID-19. For children who have been infected, their next dose can be delayed three months from when symptoms started or, if they did not have symptoms, when they received a positive test,” according to the CDC.

Studies conducted by the CDC and published last year found that for people who had already had a COVID-19 infection, they were twice as likely to be reinfected with the virus than those who were fully vaccinated after contracting COVID. 

Which vaccine is more effective? How are they different? 

Shows a little boy from behind. he's wearing a mask against the coronavirus/ COVID and he's getting a vaccine to prevent it.
Starting June 21, children 5 years old and as young as 6 months old can receive a COVID vaccine. Photo credit: Quinn Dombrowski, Flickr Creative Commons

The Pfizer vaccine for children 6 months to 4 years old is given in three doses, while the Moderna vaccine consists of two shots.

Although both the Moderna and the Pfizer vaccines use the same mRNA technology to generate an immune response, the two vaccines are different because they have different amounts of the mRNA in the vaccines, they have slightly different ingredients and different delivery systems.

For children under 5, the Moderna vaccine which has 25 micrograms of mRNA material, is a two-dose series, with four weeks between the two doses. According to the FDA, the vaccine was about 50% effective for infants and toddlers after the second shot. The vaccine had a lower effectiveness of only about 39% for preschool-aged children than it had for older children or for adults. 

Children who are immuno-compromised can receive a third Moderna dose. 

The Pfizer vaccine, which has 3 micrograms of the active mRNA ingredient, is a three-dose series, with a three week interval between the first two shots and a third dose administered at least eight weeks after the second dose for children aged 6 months through 4 years.

The Pfizer series of shots had better effectiveness for children under 5, but the trade-off for parents is the logistics of getting their children in for that third shot. 

“It's very complicated to decide what the right thing to do is for an individual child,” Diasio said. “That’s why you should consult with a pediatrician.”

How long before COVID protection kicks in? 

It will take several weeks after the final shot in either series for a child to have full protection from COVID, according to pediatricians.

Each dose, though, provides more protection from severe illness than going without one.

Where can I go to get my child vaccinated?  

Across the country, children 3 years and older can receive their vaccine at participating pharmacies. The CDC recommends checking with your local pharmacy’s website to see if vaccination walk-ins or appointments are available for children before you visit. 

“All local health departments will receive vaccines, and more than 300 pediatric offices in North Carolina have enrolled to provide the vaccine and will be receiving shipments from NCDHHS,” according to the state health department. 

Find a vaccine for your child based on their age, your ZIP code and preferred vaccine (Moderna or Pfizer) using this online tool at the DHHS website.

Why can’t you get vax at the pharmacy for kids under 3? 

Although the Public Readiness and Emergency Preparedness Act for Medical Countermeasures Against COVID-19 allows pharmacies to administer childhood vaccines, the Advisory Committee on Immunization Practices made the recommendation for children ages 3 to 18.

North Carolina law allows pharmacists to give children vaccines if they are 5 or older, according to Jay Campbell, executive director of the North Carolina Board of Pharmacy, but the PREP Act supersedes state law, he said.

Part of the reason for setting the limit at 3 years old, Campbell added, was because pharmacists aren’t trained to administer vaccines as a pediatrician would for a younger child — in the thigh area.

Kids’ symptoms are so much less severe than adults’, why bother? 

Data from the American Academy of Pediatrics show a total 13,624,605 children were diagnosed with COVID since early 2020, a number that’s likely higher as many children showed few or no symptoms. More than 83,000 children were diagnosed with COVID-19 in the last week alone.

All told, North Carolina has had more than a half-million pediatric cases diagnosed since the beginning of the pandemic, more than 18% of all the children in the state. And a recent study showed that about a third of children who got infected with the disease didn’t make any antibodies, and their long-term immunity didn’t kick in either. So a vaccine would improve those children’s chances of fighting off the SARS CoV2 virus.

Twenty-two children in North Carolina have died as a result of COVID-19 disease since the beginning of the pandemic.

While children are less likely to become seriously ill after an infection by the SARS CoV2 virus, they are not risk free. Hundreds of thousands of children across the country ended up in the hospital as a result of COVID-19 disease. 

Furthermore, in North Carolina, between 200 and 300 children have been affected by MIS-C (multisystem inflammatory syndrome in children), a rare complication of COVID-19 disease that causes inflammation in organs such as the heart, lungs, kidneys, eyes, brain, skin, eyes or gastrointestinal system. 

While clinicians first saw cases of MIS-C in children in the beginning of the pandemic, the incidence of the condition rose sharply at the beginning of the Beta wave in late 2020 and was higher through the Delta wave last fall and the Omicron wave last winter. 

Health care providers also worry that children could pass along the disease to more vulnerable family members, such as elderly grandparents or someone who is immune-compromised. 

Research has shown that people who have been vaccinated are less likely to transmit the virus. 

Finally, there are kids who’ve died, many more than with other preventable childhood diseases. According to the Centers for Disease Control and Prevention, 1,235 children under the age of 15, have died from COVID-19 infections over the past two years, with 485 of those deaths occurring in children younger than 4. 

In comparison, the U.S. vaccinates children against measles regularly, and in 2019, 1,249 cases of that disease were reported across the country with no deaths reported. According to the CDC, more than 90% of children are vaccinated against measles, which has provided strong protection against serious illness and death.

Are there side effects from COVID-19 vaccine in kids?

The temporary side effects from the COVID-19 vaccine in smaller children are similar to that of adults, according to NCDHHS. “Your child may temporarily experience a sore arm, headache and be tired or achy for a day or so,” according to NCDHHS.

Side effects such as fever are a sign that the immune system is working and generating a response to the vaccine. Fever is a normal part of getting a vaccine and that fatigue is, in part, something that occurs because the body is using energy to create antibodies. 

From the CDC website: 

  • The federal government is providing COVID-19 vaccines free of charge to everyone living in the United States, regardless of their immigration or health insurance status.
  • Check with your child’s health care provider about whether they offer COVID-19 vaccines.
  • Check your local pharmacy’s website to see if vaccination walk-ins or appointments are available for children older than 3.

This article first appeared on North Carolina Health News and is republished here under a Creative Commons license.

North Carolina Health News is an independent, non-partisan, not-for-profit, statewide news organization dedicated to covering all things health care in North Carolina. Visit NCHN at northcarolinahealthnews.org.

COVID-19, vaccine, pediatrician, Moderna, Pfizer, Centers for Disease Control and Prevention, N.C. Department of Health and Human Services