If there’s one thing that the pandemic has taught us, it’s the vital importance of vaccines.
We’ve all witnessed first-hand the chaos that ensues when a virus is able to spread unbridled throughout the community, before modern medicine has had a chance to catch up.
Throughout all the horror, our hopes have continually rested on the possibility of an effective COVID-19 vaccine. Now that it is finally a reality for adults, parents across the world are clamouring to enrol their kids in the first COVID-19 vaccine trials in young children, so that they may also be protected.
And yet there are sections of society who remain hesitant about vaccines in general and reluctant to immunise their children against any diseases at all – something that can put all of us at risk, says Dr Bariah Dardari, Consultant Pediatrician at Fakeeh University Hospital. “It’s crucial to have a trusted relationship between parents and their pediatrician to help guide them through the barrage of vaccine misinformation,” says Dr Dardari. “Reminding modern society of the devastating alternative of not vaccinating our children, in which we see the re-emerging of vaccine-preventable disease, also plays an important role.”
This World Immunization Week, we look at the importance of immunization in children, as well as the prospects of a COVID-19 vaccine that is deemed to be suitable for kids.
Why are childhood vaccines important?
Childhood vaccines are crucial to protect children against life threatening diseases, such as meningitis, polio and tuberculosis, says Dr Bariah Dardari: “While many of these diseases are much less prevalent due to vaccination programs, we have seen a re-emergence of vaccine-preventable diseases in recent years due to the ‘anti-vax’ trend – an anti-vaccination trend, whereby certain parents are against vaccinating their children.”
For example Measles - a serious disease that kills around 100,000 children a year - was deemed eliminated in the US in the year 2000. But 2016 research by the University of Emory in Atlanta found that there had been 1,416 measles cases in the country following elimination - the majority of which were intentionally unvaccinated.
“Vaccination is proven to be the most effective way to prevent and in some occasions, eradicate diseases,” said Dr George Michailidis of Genesis Healthcare Center in Dubai. “Smallpox is a great example. A deadly disease that killed 30% of those infected and is estimated to have killed up to 300 million people in the 20th century, it has now been eradicated due to vaccinations against it, and the last naturally occurring case was diagnosed in 1977.”
Vaccination during a pandemic
Unintentional gaps in routine vaccination coverage due to pandemic-related disruption are putting millions of children around the world at risk of life-threatening illnesses such as polio, yellow fever and diphtheria, according to UN health agencies, and has led to serious measles outbreaks in countries like Pakistan and Yemen. The agencies warn that this is likely to lead to future epidemics as more regular childhood vaccinations are missed.
“The COVID pandemic has made it more difficult for parents across the globe to access health care due to lockdowns, fear of doctor visits, loss of health coverage, etc,” says Dr Dardari. “The misinformation around vaccine was a major obstacle even before the pandemic, and continues to be a major hurdle due to the easy access to the widespread misinformation on social media.”
For those of us in countries where regular vaccines are still easily accessible, “vaccinations of young children should be a top priority,” says Dr Nitin Verma, Consultant Paediatrician, Kings College Hospital, Dubai Marina and Dubai Hills. "Vaccines given between 0 and 24 months of age are vitally important in disease prevention across a cohort of infectious diseases," says Dr Verma. "In these unusual times, short-term delays may be acceptable but further than that, it can potentially put your child at a greater risk of getting unwell with a vaccine-preventable infectious disease."
Are COVID-19 vaccines suitable for children?
As of today, no COVID-19 vaccines have been authorized to be used in children below 16 years of age, says Dr Sanjay Perkar, Specialist Pediatrician at Fakeeh University Hospital. “Although different types of vaccines are in different stages of vaccine trials, the results have not yet been completely analyzed and released. It might take another few months to know the exact results of these studies.”
In the UAE the Dubai Health Authority expanded the age limits for vaccination in March 2021 to 16 years and above for the Pfizer-BioNTech vaccine, and 18 and above for the Oxford-AstraZeneca jab. The Sinopharm vaccine became available to children aged 16 and above in January 2021.
Vaccines are not generally made available to children at first as they are seen as 'vulnerable’, and require a different dosage to adults, so they were not included in the original vaccine trials. However, several of the different vaccines are now running trials to include children as young as 6 months old in different countries around the world.
COVID-19 vaccine research so far
As of April 2021, trials of the COVID-19 vaccine on children are as follows:
- Sinopharm and Sinovac are reported to have conducted trials including children in the age group range 3-17 years, but the details are not yet out.
- Pfizer and Moderna have enrolled kids from 6 months and above in their trials – results are pending.
- Oxford-AstraZeneca: Vaccine trials in children have been paused pending review related to the possible link with very rare blood clot complications issues.
Are children likely to respond differently to adults to COVID-19 vaccines?
Kids’ immune systems work in a different way compared to adults, says Dr Perkar. “Their immune system is still learning about different bugs and how to react to them.”
Because children’s immature immune systems have not seen many pathogens before, they are more likely to produce a strong response to vaccines. In a preliminary analysis of the Pfizer vaccine trials, it was found that there were much higher antibody levels in the age group 12-15 years compared to the 16-25 year group. This could have an impact on the dosage that children are required to have, as well as the side effects they are likely to experience.
“Another significant factor to consider is the routine childhood vaccinations and how they might interact with each other,” points out Dr Perkar. “Further studies will guide us regarding the exact dose and number of vaccine shots needed in the kids.”
Is it even necessary to vaccinate children?
“Children are not at a lower risk of COVID-19 than adults,” says Dr Perkar. “Almost anyone could get infected.”
He says that although the incidence of COVID-19 seems to increase with increasing age, this could be due to people being more reluctant to test children, as well as a knock-on effect from school closures and community mitigation measures.
Nevertheless, children do seem to be less likely to experience severe symptoms when they do get infected: “Various studies quote different percentages but overall, 16-50 % of the kids are asymptomatic,” says Dr Perkar.
But this does not mean it is not dangerous for children – although very rare, the paediatic multi-system inflammatory syndrome that has been linked with even mild cases of COVID-19 can be very serious, even deadly.
It’s also generally agreed by the medical community that vaccinating children will be necessary in order to prevent unvaccinated children spreading possibly mutated versions of the virus.
What are the other major vaccinations my child needs?
While we await the results of the COVID-19 vaccine trials on children, doctors are keen to emphasise the importance of children receiving their routine vaccinations which have already been proven to be safe and effective for kids.
Immunisation schedules are different depending on where you live in the world. This is because in some areas the risk of getting certain infections is higher; for example, the risk of getting TB in the UAE is different to the risk of it in some parts of Europe, so it’s recommended for all babies born in the UAE to be immunised against TB in the first few days of birth. For expats this can sometimes cause complications in terms of what has been given in one place and what is needed after re-location.
“Vaccine schedules differ from country to country, but the majority focus on vaccinating children from 0-2 years when their immune system is not fully developed, with several booster shots into the teenage years,” says Dr Dardari.
“The most important vaccines are the six-in-one vaccines, which protect against six of the most common diseases, such as pertussis and polio among others. Vaccines that protect against meningitis are also very important, including pneumococcal and meningococcal vaccines.”
Children continue to need booster doses up to age of 16, and even into adulthood for some vaccines, such as the varicella vaccine.
“The schedule is always flexible and we have different catch up schedules for children who missed previous vaccines, which has been the case during the COVID pandemic.”
It is recommended for babies of any origin living in Dubai to have this vaccine againstserious bacterial lung infection TB (tuberculosis) in the first few days after birth.
HEPATITIS B (HBV)
Hepatitis B is a major cause of serious liver disease. The younger someone is when they get hepatitis B disease, the worse the consequences. Children do not show symptoms like adults do. If infected at a young age, children are more likely to go undiagnosed and become a chronic carrier of the virus. Chronic carriers have lifelong problems and issues from this infection. The vaccine is inactivated and cannot cause Hepatitis B disease.
DIPTHERIA, PERTUSSIS, TETANUS (DTP/DTaP)
DTaP is a vaccine which helps children under seven develop immunity to three deadly diseases caused by bacteria: diptheria, tetanus and whooping cough (pertussis).
Diptheria is a respiratory disease that can cause breathing problems, paralysis, heart failure and death. It is highly contagious and is spread by coughing and sneezing.
Tetanus, or lockjaw, is caused by a bacterium often found in soil. It attacks the nervous system, causing muscle spasms and death if left untreated.
Pertussis causes severe coughing spasms which lead to difficulties eating, drinking and even breathing. It is highly contagious and can lead to pneumonia, seizures, brain damage and death.
HAEMOPHILUS INFLUENZA TYPE B (Hib)
This vaccine gives long-term protection against Haemophilus influenza Type B and those who are immunised are also protected against Hib meningitis, pneumonia, pericarditis (an infection of the membrane surrounding the heart), as well as bacterial infections of the blood, bones and joints.
Rotavirus protects against the rotavirus infection which causes diarrhoea and vomiting in young children. This vaccine is administered orally.
Poliomyelitis (polio) is a serious illness that is caused by a virus. There has been a dramatic reduction in cases of polio since routine vaccination was introduced in the mid-1950s. According to the World Health Organization the United Arab Emirates has been polio-free since 1992.
But the infection has not been completely eradicated in some parts of the world, including Pakistan, Afghanistan and Nigeria, and there remains a small risk it could be re-introduced in countries where it has been eradicated, especially given the increase in international travel.
Most people with polio won’t have any symptoms and will not know they are infected. In a small number of cases, the polio virus attacks the nerves in the spine and base of the brain. This can cause paralysis which is usually temporary. However, a few people with the infection are left with muscle weakness, shrinking of the muscles, tight joints and deformities including twisted feet or legs.
This is why it is so important to make sure you and your children are fully vaccinated against it.
MEASLES, MUMPS, RUBELLA (MMR)
Measles, mumps and rubella (German measles) are highly infections conditions that can have serious, potentially fatal complications, such as meningitis, swelling of the brain and deafness. They can also lead to complications in pregnancy that affect the unborn baby and can lead to miscarriage.
The pneumococcal vaccine protects against serious and potentially fatal pneumococcal infections which are cause by the bacterium Streptococcus pneumoniae. They can lead to pneumonia, septicaemia and meningitis.
The Pneumococcal conjugate vaccine (PCV) is used to vaccinate children under 2-years-old in Dubai.
Hepatitis A is a form of viral hepatitis transmitted in food, causing fever and jaundice.
The Varicella vaccine, which protects children against chicken pox is routinely given to children in Dubai after their first birthday, with a booster given when they are six. In the UK, it is not included in the immunisations programme and there are divided opinions on whether it is completely necessary.
Chickenpox is generally a mild illness in children. As you get older is becomes increasingly severe.
Chicken pox can be a nasty illness but complications are rare and children normally recover quickly.