Portcullis Surgery

Portcullis Surgery

Portcullis Lane, Ludlow, SY8 1GT

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NHS

Telephone: 01584 872 939

Fax: 01584 879 031

portcullis.surgery@nhs.net

Covid-19 vaccine for children 12-17 years of age who are vulnerable

The Joint Committee on Vaccination and Immunisation (JCVI) has advised that children aged 12 to 15 with

  • severe neurological conditions,
  • Down’s syndrome,
  • immunosuppression or multiple or severe learning disabilities should receive two doses of the Pfizer vaccine.
  • This recommendation extends to 17-year-olds who are within three months of their 18th birthday,
  • and children as young as 12 who live with an immunosuppressed individual.

The UK’s Medicines and Healthcare products Regulatory Agency (MHRA) last month authorised use of the Pfizer vaccine in children aged 12-15, concluding that it is safe and effective to use in this age group. Israel, France and the US have also begun rolling out the Pfizer vaccine in children.

Please read the information below regarding the latest research on Covid 19 vaccines in children FIRST.

INFORMATION REGARDING COVID-19 VACCINES IN CHILDREN 12-17 YEARS

The latest research regarding Covid-19 vaccines is in the Green Book

https://www.gov.uk/government/collections/immunisation-against-infectious-disease-the-green-book

WHAT ARE THE RISKS OF COVID IN CHILDREN?

Fewer than 5% of COVID-19 cases are amongst children and in general they appear to exhibit mild disease. Although cough and fever are the main symptoms in children (Ladhani et al, 2020), a UK study tracking children of healthcare workers has recently shown that of those who were seropositive, gastrointestinal symptoms were also commonplace (Waterfield et al, 2020).

Preliminary evidence suggested that not only do children have a lower susceptibility to SARS- CoV-2 infection, but they are also unlikely to be key drivers of transmission at a population level (Viner et al, 2020). The researchers said children under 18 face an approximately one in 50,000 chance of being admitted to intensive care with Covid-19. A recent prospective study found higher secondary attack rates where the household had a positive case in a child (LopezBernal J et al, 2020).

A spectrum of multi system inflammatory disease similar to Kawasaki disease (KD) was recently described in children admitted during the SARS-CoV-2 pandemic, temporally associated with severe acute respiratory syndrome attributed to SARS-CoV-2 (Paediatric multisystem inflammatory syndrome temporally associated with SARS-CoV-2 infection (PIMS-TS)) (Whittaker et al, 2020). This severe presentation in children is extremely rare, but appears to encompass a wide range of features, including fever, gastrointestinal symptoms, rash, myocardial injury and shock (Swann et al, 2020).

Under current JCVI guidance, those aged 16 to 18 can already receive a vaccine if they are clinically vulnerable or at high risk of Covid-19 due to underlying health conditions.

The decision to vaccinate 12- to 17-year-olds who are susceptible or living with immunosuppressed individuals has been taken to offer greater protection to those people who may not be able to generate a sufficient response from the vaccines. The JCVI is keeping its guidance under review and will adjust it accordingly to the data it receives over the coming weeks.

VACCINE TRIALS IN CHILDREN

SARS-CoV-2 vaccine trials have only just begun in children and there are, therefore, very limited data on safety and immunogenicity in this group. Children and young people have a very low risk of COVID-19, severe disease or death due to SARS-CoV-2 compared to adults and so COVID-19 vaccines are not routinely recommended for children and young people under 16 years of age.

There are currently very limited data on clinical risk factors in childhood, but children with neurological comorbidities are over-represented in those who develop severe COVID-19 requiring intensive care and those who die of COVID-19. Given the increased risk of exposure to infection and outbreaks in institutional settings, vaccination may be considered for children with serious neuro-disabilities (including cerebral palsy, severe autism and Down’s syndrome) who spend regular time in specialised residential care settings for children with complex needs. As older children have higher risk of acquiring and becoming sick from infection and there are some safety data on the Pfizer BioNTech COVID-19 mRNA Vaccine BNT162b2 in children aged 12 years and older, vaccination of older children in these settings should be considered using either vaccine.

As this would be outside the terms of the MHRA approval, this would be considered unlicensed use. (https://www.gov. uk/government/publications/supply-unlicensed-medicinal-products-specials)

SIDE EFFECTS OF PFIZER

Local reactions at the injection site are fairly common after Pfizer BioNTech COVID-19 mRNA Vaccine BNT162b2, primarily pain at the injection site, usually without redness and swelling. Systemic events reported were generally mild and short lived (Walsh et al, 2020). In the final safety analysis of over 21,000 participants 16 years and older, the most common events were injection site pain (>80%), fatigue (>60%), and headache (>50%). Myalgia, arthralgia and chills were also common with fever in 10-20%, mainly after the second dose. Most were classified as mild or moderate. Lymphadenopathy was reported in less than 1%. (Polack et al, 2020). Four cases of Bell’s palsy were reported in vaccine Chapter 14a – 16 COVID-19 – SARS-Cov-2 Chapter 14a – COVID-19 – SARS-CoV-2 December 2020 recipients in the trial. Although within the expected background rate, this will be monitored closely post-implementation.

CONTRAINDICATIONS TO PFIZER VACCINE

There are very few individuals who cannot receive the Pfizer-BioNTech vaccine. Where there is doubt, rather than withholding vaccination, appropriate advice should be sought from the relevant specialist, or from the local immunisation or health protection team.

The vaccine should not be given to those who have had a previous systemic allergic reaction (including immediate-onset anaphylaxis) to:

● a previous dose of the same COVID-19 vaccine1

● any component (excipient) of the COVID-19 vaccine

The Pfizer BioNTech COVID-19 mRNA Vaccine BNT162b2 contains polyethylene glycol (PEG), which is from a group of known allergens commonly found in medicines and also in household goods and cosmetics. Known allergy to PEG is extremely rare but would contraindicate receipt of this vaccine. (Sellaturay P et al, 2020). Patients with undiagnosed PEG allergy may have a history of unexplained anaphylaxis or of anaphylaxis to multiple classes of drugs (see precautions).

If after reading the information you would like your child to be considered for the Covid-19 vaccine please fill in the form below

Enquiry about children 12-17 year olds eligibility for priority group vaccination for Covid 19

The evidence on the harms and benefits of vaccination has been reviewed by the UK's Joint Committee on Vaccination and Immunisation (JCVI). It has recommended vaccinating children aged 12-17 if they are at higher risk of Covid due to: Severe neurodisability (which could include conditions such as cerebral palsy, autism or epilepsy) Down's syndrome A severely weakened immune system, including some children with cancer Profound and multiple learning difficulties The JCVI has also recommended immunising 12-17 year olds who live with people who have a suppressed immune system, as a form of indirect protection. If you feel that your child is eligible and they would like to be identified as eligible for the vaccine please fill in this form.
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