Should I vaccinate my child?

So many parents are trying to make an important decision this week. Should I get my child vaccinated? We spoke with Rebecca Bell, MD, a pediatric critical care physician with the University of Vermont, on Medical Matters Weekly last week, and distilled her most important ideas in this quick and easy guide.

What are the real risks associated with getting COVID? Most children who get infected with COVID will not need to come into the hospital. In fact, often, they need no treatment at all. But, they do suffer other consequences. They miss school. They have to quarantine. It is very disruptive.

A certain percentage of kids with COVID will get severe disease and need to be in the hospital. How do you know if your kid is at risk of being one that will get severe disease? We don’t know. In fact, a lot of previously healthy children get admitted to the hospital. There is no way to predict which children will be more severely ill.

What does a serious case of COVID look like in kids? COVID looks different in kids of different ages. Adolescents tend to get something similar to what we see in adults. They get severe pneumonia. They need a lot of oxygen and a lot of help breathing. Much of the damage in the body is actually caused by an unprepared immune system working really hard to get rid of the virus. We give therapies like steroids to damp down the immune system response. Other medications to control the immune system response may be necessary as well. Because the blood vessels can get inflamed, we give blood thinners to avoid blood clots. Recovery from COVID pneumonia in previously healthy hospitalized children takes longer than recovery from other pneumonias.

In infants, we see fevers and systemic inflammation. Babies who don’t feel well may stop drinking and need hospital treatment for dehydration. They may also have difficulty breathing.

Elementary-aged kids, the group that is newly eligible to get the COVID-19 vaccine, are susceptible to pneumonia and also MIS-C, multisystem inflammatory syndrome in children. About 5,500 children in the United States have gotten MIS-C related to COVID. They get infected with what appears to be a mild case, but a month later, they experience systemic inflammation that can affect the heart and other organs. Treatment for this requires steroids and other therapies and help support blood pressure and heart function.

As a percentage, all of these conditions are rare, but they become more prevalent as the number of COVID cases in these groups increase.

Wouldn’t getting COVID naturally build my child’s immune system? Many people do have evidence of some immunity after COVID infection. However, infection-induced immunity is less predictable and not as long-lasting as vaccine-induced immunity. And you have to get sick to get infection-induced immunity. Vaccination is the safest and most predictable way to achieve immunity.

The vaccine encourages your child’s body to build the immunity before the real virus arrives. With the vaccine, there is no virus and so no virus replicating. The vaccine gives your child’s body instructions to make a spike protein to show your immune system, so your immune system can prepare in a controlled way. The immune system does not go into overdrive.

Vaccinations are not like standard medications. With vaccination, nothing in the body is modified or changed. Instead, the vaccine presents information to your immune system and then the body reacts in a way that it normally would.

What are the common side effects? People who are 5 – 11 years old in the vaccine clinical trial reported having a sore arm and sometime redness and swelling at the injection site at about the same frequency as adolescents and young adults. They reported fewer systemic side effects (fatigue, headache, muscle aches) than adolescents and young adults, likely due to the smaller dose.

I am worried about my child’s fertility or other long-term side effects. It’s natural to worry about long-term side effects. Vaccine side effects, even very rare ones, are seen within 6 – 8 weeks of receiving the vaccine. Because the vaccine presents information to the body and then goes away, there is no biologic reason for a problem to show up years down the line.

Because this vaccine has been given to hundreds of millions of people, including many millions of adolescents, even very rare side effects have been picked up. In adolescent males and young men the risk of myocarditis (inflammation of the heart muscle) in the week after the second dose increases above the typical baseline rate of myocarditis in this population. This is called vaccine-associated myocarditis, and it is very rare: dozens of cases per million doses in this demographic. In fact, it is more rare and more mild than myocarditis caused by the COVID infection.

I fear I may regret getting my child vaccinated. That is an understandable feeling, especially because this vaccine is new for children. But hundreds of millions of people have received this vaccine, and we have reassuring data that it is safe and effective. On the other hand, we are still learning about the long-term of effects of the virus that causes COVID-19. There is more uncertainty in how the virus will affect our children long term than the vaccine.

The SARS-CoV-2 virus is not going away. Vaccination will prepare a child’s immune system to be ready for that eventual exposure. This decreases the likelihood of severe disease.  Choosing not to vaccinate is an active decision too, and you could also feel regret at having not vaccinated. Even delaying the vaccine comes with substantial risks at this phase in the pandemic. While there are no absolutely risk-free options, the vaccine comes with far fewer risks than the disease.

If you have additional questions, please join pediatricians from around the state for a series of open forums on the topic of vaccinations for your child. More information at http://www.aapvt.org/news/join-us-conversation-about-covid-19-vaccines-children.