Question: I have two middle schoolers. In terms of COVID vaccine, would they need to wait until pediatric tests/trials are completed? They received the “adult” flu vaccine, just like me.
Answer: Children’s immune systems differ from adult’s systems, so it’s especially important to understand the degree to which a new vaccine impacts children through rigorous safety and efficacy evaluation. Your middle schoolers will not be eligible to receive the vaccine until vaccine safety/efficacy data for their age-group have been reviewed and the FDA has provided emergency use authorization (EUA). Even with authorization, it may still be some time before your kids receive the vaccine due to limited supply and vaccine prioritization. When it comes to your experience with influenza vaccine, the reason that they can receive the “adult” flu vaccine is because it has been proven safe and effective for them thanks to years of scientific research. Read on for a bit more on timeline, priority populations, and the influenza vaccine.
Safety/efficacy data timeline: Pfizer expanded its trial participation to include those ages 12+ back in October (see Q&A of 11/10) and expects to have data from those ages 12-17 in a few weeks (per Pfizer call I was able to participate in yesterday). Pfizer is developing its pediatric study plan and hopes to receive FDA approval to begin implementation soon (after safety/efficacy is proven for older children). Meanwhile, Moderna announced last week plans to expand its vaccination trials to those ages 12-17, but according to clinicaltrials.gov, the study is not yet recruiting.
Priority populations: The Advisory Committee on Immunization Practice (ACIP) issued its recommendations on Phase 1A priority populations last week and CDC adopted these recommendations as guidance. It is, however, up to each state to develop its own prioritization. ACIP has also shared its initial thinking on prioritized Phase 1 populations in publicly available slides from its November meeting. As Table 1 shows, after healthcare personnel and long-term care facility residents, the next prioritized population is essential workers, followed by adults with high-risk medical conditions and adults ages 65+. It will be quite a long time (many months into 2021) for children (who we still need safety/efficacy data for) and the general population to be eligible for the vaccine. If you’re curious about where you may be in the line, the NY Times offers this data visualization, Find your place in the vaccine line.
Influenza vaccine: CDC recommends that “all persons aged ≥6 months who do not have contraindications should be vaccinated annually.” The dosing varies by age and influenza vaccination history. Those ages 9+ requiring only one dose of influenza vaccine. There are several types of influenza vaccines, some of which are the same for adults and children, and some of which are intended for those ages 18+ or 65+ (see MMWR Table 1). The history of influenza vaccination in children is a long one that is well described in this article published back in 2013 in the Journal of the Pediatric Infectious Disease Society, Overview of Influenza Vaccines in Children.
Table 1: ACIP Proposed Phase 1 Sequence
