School-related Covid-19 clusters have increased substantially in Malaysia since the reopening of schools, especially with the most recent wave of cases due to the SARS-CoV-2 Omicron viral variant.
Most children who are infected stay asymptomatic (i.e. have no symptoms), but they may easily transmit the virus to others, including those who are at higher risk of severe diseases.
According to the CovidNow website, children aged five to 11 years old have made up about 10% of the country’s total Covid-19 cases in recent weeks.
It is predicted that the incidence among younger children will increase further.
Following the vaccination drives for adults and adolescents, Malaysia has started to roll out the Covid-19 vaccination programme for children.
Many countries like the United States, Canada, Germany, Austria, Belgium, Hungary, Greece, Singapore and Indonesia started vaccination for children aged five to 11 late last year (2021).
Safe for kids
Many parents in Malaysia are concerned about the safety profile of the Pfizer-BioNTech vaccine for younger children, as this is the sole vaccine the government is providing through the National Covid-19 Immunisation Programme for Children (PICKids).
The following are the findings of studies on the efficacy and safety of the vaccine for this age group.
According to the US Centres for Disease Control and Prevention (CDC), the Pfizer-BioNTech Covid-19 vaccine was administered to 3,109 children aged five to 11 years in a clinical trial prior to receiving approval.
Most of the adverse events reported by the children and their parents during this trial were mild to moderate.
These included pain at the injection site, headaches and mild fever, which the child usually recovered from within a few days.
No serious adverse events related to vaccination were reported during this trial.
After approval for emergency use of the vaccine in this age group was granted by the US CDC, the agency reviewed adverse events related to administration of the vaccine in American children as reported to their Vaccine Adverse Event Reporting System (VAERS) from Nov 3 to Dec 19, 2021.
Approximately 8.7 million doses of this vaccine were administered to children aged five to 11 years old in the United States during this period.
The VAERS received 4,249 reports of adverse events after vaccination in this age group, 97.6% of which were not serious.
There has been some concern over cases of myocarditis and pericarditis following the administration of mRNA (messenger ribonucleic acid) vaccines, of which the Pfizer-BioNTech vaccine is one.
Myocarditis is a rare, but serious, adverse event that has been associated with such vaccines.
As a vaccine side effect, it appears to be reported most frequently in males aged 12–29 years.
However, to date, myocarditis among children aged five to 11 appears very rare, with approximately 11 cases in 8.7 million child vaccine recipients (0.00013%).
Myocarditis was well-described long before the Covid-19 pandemic.
It can occur when a virus, such as those that cause the common cold, influenza, or indeed, SARS-CoV-2 (which causes Covid-19), infects the body.
Fortunately, current studies show that vaccine-related myocarditis is typically much milder than classic myocarditis due to viral infection.
The symptoms last for a shorter amount of time and usually resolve with minimal, if any, medical treatment.
In two recently-published randomised controlled trials on the Pfizer-BioNTech vaccine in children and adolescents, the investigators reported that the vaccine achieved over 90% reduction in the risk of contracting Covid-19 for children five to 11 years old, as well as adolescents.
No serious adverse events, such as myocarditis, were observed during the period of the studies.
However, as with adults, mild reactions such as pain at the injection site, fatigue and headache were reported.
Parents and guardians of children aged five to 11 who received the Pfizer-BioNTech vaccine should be informed of the possibility of such reactions after vaccination.
It should be noted that such reactions are more likely to occur after the child receives their second dose.
Parents should also advise their child to avoid strenuous exercise for up to a week after vaccination.
Don’t wait and see
Some parents are considering opting out of vaccinating their children in the hopes that herd immunity will protect them.
Traditionally, herd immunity is achieved when 80% of the population have been fully immunised against an infection.
But this is not so with Covid-19, especially now with the new Omicron viral variant.
We will likely need more than 95% of the population fully immunised to achieve a degree of protection similar to that conferred by herd immunity.
Currently, our population of those vaccinated stands at 79%.
Furthermore, herd immunity is a dynamic phenomenon that depends on the movement of the “herd”.
For example, if a family has five adults and one child, and all the adults are immunised, then one can say that the family has herd immunity.
This is provided that the family members all live in the same house all the time, and the child never spends any time outside.
If the child goes to school, then the “herd” becomes all their schoolmates, teachers and other school staff.
If all the children (or any adults) who are not immunised congregate there, then there is no herd immunity in that setting.
This may be exacerbated if there are parents adopting a “wait and see” approach to their children’s vaccinations because of worries over its possible current and long-term side effects.
We are unlikely to be able to achieve the 95% immunisation rate to gain herd immunity if this occurs.
There are already certain groups of children who are unable to receive the Covid-19 vaccine even if they wanted to because of their health status.
If a certain number of parents opt not to immunise their children, in addition to this group of ineligible children, then the 5% margin for herd immunity will quickly be exceeded, spelling big trouble for the general level of immunity among children.
Consequently, the risk of their children contracting the virus, particularly with more contagious variants like Omicron, is significantly higher.
Keeping our guard up
Some believe that we should now be treating Covid-19 like a normal flu, but it is not advisable to let down our guard just yet.
The current phenomena of an apparently milder course of illness when one contracts the Omicron variant is the result of having our immunity propped up by vaccination.
The illness will certainly be more serious across the population if most of us were not vaccinated.
Vaccination is still the most effective way to prevent Covid-19 and the development of serious complications.
It reduces the likelihood of transmission within the home and in school settings, helps safeguard vulnerable persons and creates a safer in-person learning environment.
Without effective Covid-19 vaccines for this age group, children could potentially become ongoing reservoirs of infection and sources of new SARS-CoV-2 viral variants.
Widespread vaccination across all eligible age groups is therefore essential in the ongoing efforts to curtail the pandemic.
In a nutshell, children aged five to 11 years old are encouraged to be vaccinated against the SARS-CoV-2 virus.
Nevertheless, if the child has any pre-existing medical conditions or if parents have any doubts, do seek advice from your family doctor or paediatrician before making any final decisions about vaccination.
Dr Lim Yin Sear is a senior lecturer at Taylor’s University School of Medicine and Dr Noor Hafiza Noordin is the head of Hospital Banting’s Paediatrics Department. For more information, email email@example.com. The information provided is for educational and communication purposes only, and should not be considered as medical advice. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this article. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.