There is still no approved vaccine for children against the coronavirus. But the first pharmaceutical manufacturers are starting to include young people in their ongoing clinical trials. In a current study with the mRNA vaccine from Biontech / Pfizer, volunteers between the ages of twelve and 16 are taking part. The fundamental question: Should children and adolescents also be vaccinated so as not to contract Covid-19? This is what Professor Johannes Liese, Head of Infectious Diseases and Immunology at the University Children’s Hospital in Würzburg, says.
Question: Do you think it makes sense to have children vaccinated against the coronavirus?
Johannes Liese: Yes, I think vaccination makes sense as soon as a vaccine for children is approved. There are also complications in children and adolescents when they contract Covid-19. They are rare, but they do exist.
What kind of complications are these?
Liese: In children between about five and 15 years of age, the “multisystemic inflammatory syndrome” occurs more and more frequently as a long-term consequence of Covid-19. It’s a serious inflammatory disease. The gastrointestinal tract, heart, skin, liver or the coagulation system are often affected. We have four children at the University Children’s Hospital in Würzburg who suffered from it and are now coming for follow-up care.
Will these children get well again?
Liese: The prognosis is usually good. But the course of the disease is protracted.
Is the British variant, the mutation B.1.1.7., More dangerous for children than the original coronavirus?
Liese: In terms of the risk of infection, yes. The variants of the coronavirus are 30 to 40 percent more contagious. Of course, this has an effect on the transmission in kindergartens and schools. In serial tests in day-care centers or during screening at the university clinic, small children have so far been extremely rarely corona-positive: on average, two or three out of 1000 tests. That seems to be changing right now. More school children, but also more daycare children, are infected than before.
Do the affected children get sick more severely?
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Liese: Apart from individual cases: no. Most diseases in children and adolescents run as a mild flu-like infection of the upper respiratory tract or even completely symptom-free.
Is vaccination in children even justified when the risk of becoming seriously ill is so low for them?
Liese: The risk is similar to that of measles: one out of every 1,000 cases results in severe meningitis. The severe inflammatory disease after Covid-19 occurs so far in about one in 1000 to 5000 children. The risk is low. But if you assume that, for example, 100,000 children go through a corona infection, then 20 to 100 children are affected. We could reduce this risk by vaccinating.
Why is it taking longer for a corona vaccine to be approved for children?
Liese: The vaccines have been tested for safety and effectiveness in adults. They now need to be checked against younger age groups. Studies are currently underway with twelve to 16 year olds. Then it is the turn of elementary school children, then kindergarten children and finally crèche children.
Does a toddler react differently to a vaccine than an adolescent?
Liese: In those over the age of twelve, the immune system’s response is usually similar to that of adults. Many people who have been vaccinated have reddening at the injection site and mild flu-like symptoms. Sars-Cov-2 infection is usually easier in children under the age of twelve. It cannot be predicted whether this is why corona vaccines will be better tolerated in children. One needs to study the safety and effectiveness of vaccines in the child’s age group as closely as it does in the adult age group.
Should you vaccinate children who are previously ill now – even if no vaccine has yet been approved for children? Would an “off-label use” be possible?
Liese: From the age of 16, young people with lung diseases can already be vaccinated. In the case of children who have an underlying disease, such as those affecting the heart or lungs, a vaccination may be useful in individual cases, even outside of the approval period. It requires careful education. The decision must be made jointly by the parents and the pediatrician who is in charge.
When do you expect the approval of corona vaccines for children?
Liese: If things go well, we can expect the first vaccines for 12-15 year olds in the fall and vaccines for the younger children over the next year. Then it is important to get the pediatricians in private practice, whom the parents trust, on board. Vaccines that only have to be given once will be attractive for children, who usually have much closer contact with their peers than adults: they could quickly immunize large parts of the young population and thus prevent the further spread of the virus.
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