The SARS-CoV-2 Omicron variant has fueled the pandemic’s fire, resulting in record-breaking case counts in the U.S., with teenagers seeing some of the highest incidence rates. As with adults, the risks of not being vaccinated are much, much higher than being vaccinated.
COVID-19 cases and hospitalizations are seven and 11 times higher in unvaccinated adolescents respectively, compared with their vaccinated counterparts. Boosting teens is important but promoting the primary vaccination series is just as crucial, according to Dr. Sandra Fryhofer, who is the AMA’s liaison to the CDC’s independent Advisory Committee on Immunization Practices (ACIP). She writes: “Only half of [the] country’s 16.7 million adolescents 12–15 years old are fully vaccinated [against COVID].” She adds, “We’ve been talking a lot about boosters, but you can’t boost until you get your primary vaccine series.”
In a recent episode of the “AMA COVID-19 Update,” Dr. Fryhofer shared new data about preventing multisystem inflammatory syndrome in children (MIS-C), the safety of booster shots, and actions to expand vaccinate eligibility to more children:
Compelling findings published in the CDC’s Morbidity and Mortality Weekly Report underscore the health risks associated with unvaccinated children. Multisystem Inflammatory Syndrome in Children (MIS-C), although still rare, “is a nightmare potential complication of COVID infection. It’s serious and can be deadly,” said Dr. Fryhofer.
A study of 12–18-year-olds demonstrated that a two-dose series of Pfizer-BioNTech vaccine, the only vaccine authorized for children, was 91% effective at preventing MIS-C. Among those children hospitalized with MIS-C, 95% had not been vaccinated. None of the vaccinated children required respiratory or cardiovascular life support, compared with 39% of unvaccinated children with MISC.
ACIP’s message on boosters, meanwhile, was concise and clear: all people 12 or older should get the vaccine booster. “With Omicron on the scene, an initial primary vaccine series alone is not enough to protect you. Everyone aged 12 and older should get a booster. No if, ands or buts,” said Dr. Fryhofer.
The CDC updated its recommendation for teens following ACIP’s vote to expand Pfizer-BioNTech boosters to kids 12–17 at least five months after their primary series. The 12 and up recommendation opens the booster to about 5 million more children.
“Studies and data from multiple laboratories show that a Pfizer vaccine booster strengthens antibody response against the Omicron variant,” said Dr. Fryhofer.
My guess is that the Moderna vaccine data, once it’s available, will allow it to be approved for the same indication.
“Myocarditis incidence among vaccinated teens has been a prevailing concern, although recent data from Israel suggest the risk is low,” said Dr. Fryhofer.
The data, which reflects five months of booster-safety data among 40,000 doses in 12–15-year-olds, yielded just two cases of myocarditis.
“We also know that myocarditis rates among 12-to-15-year-olds who received a primary series are lower than rates among 16- and 17-year-olds. In older age groups, rates of myocarditis after a third dose are lower than after a second dose,” she added.
ACIP’s Vaccine Safety Technical Work Group reviewed the most recent safety data on the primary vaccine series in 12–15-year-olds and booster doses in 16–24-year-olds and found no new safety signals.
Myocarditis risk concern is not just for vaccines, Dr. Fryhofer reported. “COVID disease itself can also cause myocarditis.” The AMA adds, “While some parents may be thinking twice about teen vaccination, medical experts reassure that the risk of myocarditis and pericarditis are far lower than the risks of serious illness or death from contracting COVID-19.”
There have been more than 1,000 reports to the Vaccine Adverse Event Reporting System (VAERS) of cases of myocarditis and pericarditis occurring after mRNA COVID-19 vaccination in the U.S. with more than 300 cases confirmed. A joint statement from the AMA and multiple medical organization reports:
The facts are clear: this is an extremely rare side effect, and only an exceedingly small number of people will experience it after vaccination.
Importantly, for the young people who do, most cases are mild, and individuals recover often on their own or with minimal treatment.
In addition, we know that myocarditis and pericarditis are much more common if you get COVID-19, and the risks to the heart from COVID-19 infection can be more severe.
The statement authors add:
The vaccines are safe and effective, and they prevent COVID-19 illness. They will help protect you and your family and keep your community safe.
We strongly encourage everyone age 12 and older who are eligible to receive the vaccine … to get vaccinated, as the benefits of vaccination far outweigh any harm.
Especially with the troubling [variants] increasingly circulating, and more readily impacting younger people, the risks of being unvaccinated are far greater than any rare side effects from the vaccines.
If you get COVID-19, you could get severely ill and be hospitalized or even die. Even if your infection is mild, you or your child could face long-term symptoms following COVID-19 infection such as neurological problems or diminished lung function.
We recommend getting vaccinated right away if you haven’t yet. It is the best way to protect yourself, your loved ones, your community, and to return to a more normal lifestyle safely and quickly.
The ongoing pandemic has also exacerbated mental health problems in children and young people. It’s affected school and college life. Dr. Fryhofer concludes, “Booster doses may help decrease transmission and could help us get through Omicron and help kids and keep kids in school and keep our country going.”
Get the latest news on the COVID-19 pandemic, vaccines and variants, and more reliable information directly from experts and physician leaders with the “AMA COVID-19 Update.”
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