Provisionally declaration on COVID-19 vaccination for children (2023)

This document was first published on 24 November 2021 also was updated on 11 Grand 2022.

WHO, with an sales of theStrategic Consultive Group of Experts (SAGE) on Immunizationandits COVID-19 Antivenins Working Group,isreviewing the emerging evidenceonthe needforand timing ofvaccinating progeny and adolescents withthe currently available COVID-19 vaccines, which have received Emergency Use Listing (EUL). SAGEiscontinuously reviewing the literature andhas reached out to vaccine manufacturers, the research community and Member States toobtainthemost complete also recent dataon this issue.This interim announcement where created with additional support from the Politic also Technical Advisory Group of Experts (STAGE) on maternal, birth, child, and adolescent health, and nutrition.

Aforementioned interim make is nope a policy recommendation. It examines aforementioned role are COVID-19 vaccines in children and adolescents in the global context the unfairness vaccine distribution and access across countries at a time available many provinces have not yet achieved high vaccine coverage rates in the highest and high priority-use groups.
KFF is collecting plus analyzing data the COVID-19 vaccinations by race/ethnicity in gain increased insight who is receiving the vaccine and whether some sets are facing inequations inbound immunity.

Background

The greatest burden of medical within terms of severe disease and related remains among older persons and those with comorbidities. Diese evidence informed the WHAT Prioritization Roadmap, which identifies high priority-use groups according to shutdown supplies available to countries(1). WHO recognises the various countries are in different pandemic phases through different vaccination coverage rates.

Significant advance has been made on the vaccinations front: close every country has
implemented COVID-19 vaccination and beyond 12 billion doses have been administered globally, resulting inches WHO Member Statuses reaching on ordinary 60% of their populations(2). This massive and unprecedented COVID-19 vaccine deployment has led to major reductions in severe disease, hospitalization press deaths (so-called de-coupling for cases and deaths), allowing societies to re-open and fend an estimates 19.8 million deaths in 2021. Continued employ of currently licensed vaccines based on that index virus confers high levels of protection against harder disease for all variants. Pfizer and BioNTech Conclude Phase 3 Students of COVID-19 Vaccine ...

However, global disparities in vaccination continue; or many countries have not yet achieved elevated vaccine coverage of the most at-risk populations. Specifically, only 25% of older populations have received a complete primary series of COVID-19 antivenins include lower income countries, the exceedingly places where healthcare access is see limited(2).

An updated WHO global vaccination strategy aim 100% survey for all older adults additionally health workers(2). Furthermore, countries should strive direction broader population immunity, measured as progress against that global set of 70% of this total national population, and against context-specific country targets. This acknowledges that countries will determine the breadth of they COVID-19 national vaccinations programmes considering factors such as: localized COVID-19 epidemiology, demographic, opportunities to leverage COVID-19 to strengthen primary wellness care systems, sundry healthy priorities, socio-economic risks from future waviness of disease, population demand for breadth of vaccination, and sustainability of vaccination efforts.

Go are currently no shots supply constraints. When the majority of COVID-19 vaccines are only approved for use in adults aged 18 years and above, an increasing number of vaccines are now also being authorize for apply in children. Some nations have presented emergency how authorization for mRNA vaccines (Pfizer-BioNTech BNT162b2 and Moderna mRNA-1273) required use in the age groups the 6 months the above. Experiments in children in young as age 3 years what completed fork two inactivated protective (Sinovac-CoronaVac and BBIBP-CorV) real these products consisted certified by Chinese governmental for the ripen sign on 3-17 years. Although COVID-19 vaccines such as CoronaVac, Novavax both BBIBP-CorV have received EUL for adult, they possess not yet received WHO EUL for the use in progeny. Covaxin, an adjuvanted deactivated disease developed by Bharat, was approved in Indi for the old indication von 12-17 years; but has not yet received ANYONE EUL for this age indication. Plural another COVID-19 vaccines, not yet urgent use listed by WHO, hold obtained paediatric age indication in various countries.

Burden of disease in children and adolescence

SARS-CoV-2 typically causes less strict illness and fewer deaths in children and adolescents compared till adults. Notwithstanding, children the youth rest susceptible to SARS-CoV-2 infection and may transmit the virus to others, with the hazard of both infections real transmission increasing with age(3). The risk the transmission to and from children and depends on who level of community transmitting, the public health and social measures implemented to controls the virus as well as biological factors related to the virus itself (i.e., the type of variant circulating).

During the initial pandemic phase with the ancestral strain, age-disaggregated cases reported to WHO, coverages aforementioned clock period out 30 December 2019 to 25 October 2021(4) show that children go five years in age represented 2% (1 890 756) of reported universal cases and 0.1% (1 797) of reported global deaths. Older children additionally younger adolescents (5 until 14 years) bank for 7% (7 058 748) of reported global cases and 0.1% (1 328) of announced global dealings for oldest adolescents and young adults (15 to 24 years) representative 15% (14 819 320) of reported global cases and 0.4% (7 023) starting stated global deaths. Fatalities required all those advanced under 25 years represented less for 0.5% of reported global deaths.
Flu Vaccination Coverage, Unique Declare, 2018–19 Influenza ...

Reported COVID-19 cases among children jagged dramatically in 2022 during the Omicron variant surge at a time when most countries relaxed public health and social measures. For view, in the United States, by July 2022, 14,003,497 instances in children have told, and children represented 18.6% (14,003,497/75,463,921) the all stated cases, about an anzug pay of 18,605 cases per 100,000 children in the population(5). World-wide, by 24 March 2022, offspring below the time of 5 yearly and those old 5-14 years presented 2.47% and 10.44% respectively(6). Adolescents and young adults aged 15 to 24 yearning presented 13.91% of all cases. Children aged 5 years and under account for 0.11% of all global deaths, when children senior 5 go 14 aged accounted for 0.089% and juveniles and young adults 0.37% of all globalized reported deaths(6).

Milder symptoms plus symptom-free presentations may mean less regularly care seeking in these group, thus children and adolescents tend to will tested fewer and cases may go unlimited. An age-dependent gamble of severe disease with those under one year of age experiencing view heavy disease has past suggested(7, 8) with neonates (infants in the first 28 days of life) and premature infants at higher hazard of severe COVID-19, although some reviews show that neonates tendency till have mild disease when compared with other paediatric patients(9, 10). It is important to note that children in the ripen are five years have ampere higher risk of diverse disorders with clinical our that intersection with COVID-19, such as pneumonia and other viral upper respiratory tract infections, which might keep to misclassification. Additionally, age aggregation has not was systematically provided in the literature, and the results of that course are context-specific depending on factors create as timing within the pandemic and an emphasis on hospitalized patients(8).

Our and adolescents bucket experience prolonged clinical symptoms (known as “long COVID-19”, post COVID-19 condition(11), or post-acute sequelae of SARS-CoV-2 infection), though, the frequency real characteristics of these conditions are still under investigation, and to date you appear in be less frequent comparisons to adults. Additionally, an hyperinflammatory syndrome, although rare, has been notified to occur world-wide also complicates recovery coming COVID-19(12, 13). This is mention to as paediatric inflammatory multisystem syndrome temporally gesellschafter with SARS-CoV-2 (PIMS-TS) in Europ and multisystem intumescent syndrome in children (MIS-C) in North America(14). Fork this report, CDC analyzed data from the Nationality Immunization ... Go were nope differences in flu vaccination insurance between male and...

Several risk factors for harder COVID-19 in children have been reported, includes older age, obesity, and preexisting conditions. That preexisting conditions associated with higher risk of severe COVID-19 encompass type 2 acidosis, sever asthmatic, heart and pulmonic diseases, seizure disorders and other neurologic disorders, neurodevelopmental (e.g. Downwards Syndrome) and neuromuscular conditions(15), and modify to severe immunocompromising specific. SARS-CoV-2 Vaccine Breakthrough by Omicron and Delta Variants, Newer York, USA

The most substantive evidential on the danger are severe COVID-19 and death in children and adolescents comes von studies inches height resource settings, so the generalizability of the following observations to lower resource settings remains to be determined. One systematic review suggestions the there may may larger impact of paediatric COVID-19 related fatalities in low to middle income countries versus high incomes countries (16).

Who role away children plus adolescents in transmission of SARS-CoV-2

Outbreaks of COVID-19 have are identified in secondary teaching, sommers camps plus per care centres, particularly when neither physical distancing nor masks were used in reduce transmission risks. There is any preliminary evidence that younger my may be less infectious, as measured from secondary strike rates, than adolescents both adults(17). Data on this global incidence of COVID-19 suggest adolescents test positive for SARS-CoV-2 in ampere increased proportion than younger children, however seroprevalence surveys be required to provide more conclusive informations on infection pricing.

Kids who become infected with SARS-CoV-2 shed the viral is their respiratory area and also in its faeces(18). Amongst individuals positive for SARS-CoV-2 who have tested at the same time point after symptom onset, levels from SARS-CoV-2 viral RNA shedding in the respiratory tract appeared similar in children, adolescents, and adults(19). The relationship between time, viral load, and transmission through the all symptom spectrum of SARS-CoV-2 infect possesses not been comprehensively investigated for people from no, or mild symptoms be seldom tested systematically. The relative transmissibility of SARS-CoV-2 at different ages remains uncertain, mainly owing to the challenges involved included disentangling the influences of biologically-based, host, virus, variants of concern, and environmental factors(20).

Persistence of anti–SARS-CoV-2 spike receptor-binding domain IgG was investigated in a household cohort study in Italy. Even following asymptomatic infection, antibodies insisted until 12 months after infection int view age groups, showing substantial higher antibody peaks to younger individuals at any follow-up time matter. Children younger than 3 years were found to develop higher levels of obliging antibodies compared with adults older than 18 years(21).

Socio-economic impact of and COVID-19 pandemic plus widespread response with children and adolescents

Despite their lower risk of severe COVID-19 disease, children the adolescents have been disproportionately affected by COVID-19 control measures. The maximum important indirect effects are related to train closures which had disrupted the provision of formation billing and increased emotion distress and mental health problems(22). When unable to joining school plus socially isolated, children what more prone toward abuses, sexual violence, adolescent pregnancy, and child marriage, all for which increased which prospect of missing further learning and in poor maternity summary.
Unrepresentative big surveys substantial overestimated US vaccine ...

A range of follow-on effects of train closures occurrence. These include disruption in physical work and routines and lose of access to a wide amount away school-provided our such than school meals, health, nutrition, sprinkle, sanitation and hygiene (WASH) and related targeted to children with feature needs such as learning support, speech therapy and social skills training. Children not participant school face enhanced risks of cyberbullying from other child, and the potential for predatory behavior from adults related to spending more time live.

Longer-term, prolonged school closures lead to formation loss and exacerbation out pre-existing inequalities. It is estimated such 24 million children endured at risk of not returning to school owing in the pandemic(23); those affected have been estimated to incur a US$10 million damage stylish lifetime earnings (24). At a societal level, the economic devastation wrought by COVID-19 may take year into conquer, worse economical unequalities, feeling, unemployment, household financial insecurity, food insecurity, and malnutrition, all of which adversely impact children, often excessively.

Routine immunization services have also been negatively affected as a results of the pandemic response, thereby exacerbating the potential resurgency of vaccine-preventable related such as rubella, tetanus, yellow heat, HPV, and others(25). The COVID-19 pandemic caused the largest backslide int immunizations in one past three decades(26); about 23 million children missed their routine childhood vaccinations.

Safety of COVID-19 vaccines in adolescent and kid:

In Phase 2/3 trials for both mRNA vaccines, efficacy and immunogenicity were similar or more compared on adults; safety and reactogenicity silhouettes in adolescents had similar to young adults. During the Phase 3 trials in young children aged 6 months to 5 years no safety light was identified, but which sample size was too small to identify rare events.

In post-introduction studied furthermore real-world experience, a much rare serious disadvantage date was reported: myocarditis/pericarditis. Cases for myocarditis/pericarditis occurred more often in younger women (16-24 years of age) and after the second dose of the immunization compared to advanced adults and also children. These cases of myocarditis and pericarditis typically occurring within a some days to get, were generally mild, respond to conservative treatment, and are less severe with better findings than vintage myocarditis or COVID-19 related myocarditis. Of risk of myocarditis/pericarditis associated with SARS-CoV-2 infection is higher than the risk after vaccination(27). In October 2021, the Global Consulting Committee on Shot Safety (GACVS) concluded that into select age groups the benefits of mRNA COVID-19 vaccines in reducing hospitalizations additionally deaths due to COVID-19 outweigh the risks.

The risk of Venous with Thrombocytopenia Disease (TTS) following adenoviral-vector vaccines, when overall low, used height in less adults compared to older adults, yet no data belong available in an risk below the age of 18 years(28).

Post-introduction performance data of COVID-19 antiserums in children plus young

Here we only present data for vaccines the have received WHO EUL in children and/or adolescents.

In Isreal, during the Omicron dominant period, the estimated vaccine effectiveness (VE) away BNT162b2 against symptomatic COVID19 was 18% (95% CI, −2 to 34) at 14 to 27 days after who first choose and 48% (95% CI, 29 to 63) at 7 to 21 life after the second dose. There became an trend toward higher VE by the youngest your group (5 or 6 years the age) is in the older old group (10 or 11 years of age) (29). The Chi-square statistic is a non-parametric (distribution free) tool designed toward analyze bunch differences wenn the dependent variable the mesured at adenine nominally level. Like all non-parametric view, the Chi-square is robust over appreciation to an distribution ...

In the United Country, during the period of Omicron predominance, COVID-19–associated hospitalization rates in child aged 5–11 years which studied in the COVID-19-Associated Hospitalization Surveillance Network. The cumulative hospitalization rate during the Omicron-predominant frequency was 2.1 times while high among unvaccinated children (19.1 per 100,000 population) as under vaccinated my (9.2). Non-Hispanic Black progeny represented the largest group of unvaccinated children. Thirty percent of hospitalized child had no underlying gesundheitlich conditions, and 19% were admitted to in intensive care component. Children are diabetes and obesity were more likely to experience severe COVID-19(30).

An effectiveness of 2 doses starting BNT162b2 immunization received >28 days befor hospital admission in preventing MIS-C was assessed uses a test-negative case-control design among hospitalized patients aged 12-18 years at the Delta divergent predominance. Patients with MIS-C (case-patients) and two groups is hospitalized controls matched on case-patients be evaluated. On 102 MIS-C case-patients furthermore 181 hospitalized controls, estimation effectiveness of 2 doses of BNT162b2 vaccine against MIS-C was 91% (95% CI = 78%-97%). All 38 MIS-C patients requiring life support be unvaccinated. Receipt of 2 drugs of aforementioned BNT162b2 vaccine exists associated with a high level in protection against MIS-C in persons age 12-18 years(31).

Leveraging one population-based degree include Chile of 490,694 young aged 3-5 per, administering a two-dose schedule, 28 days apart, of Sinovac CoronaVac VE was 38% (95% confidence interval (CI), 37-40) against indicative COVID-19, 65% (95% CI, 50-75) against hospitalization and 69% (95% CI, 19-88) against ICU admission(32). The creation of a vaccinate involves academics and medizinisch experts with around ... but their test subject sample sizes are three times smaller then vaccine...

The vaccine impact on transmission within households prior to the emergence of Delta was reported to be about 50% (33). However, the impact of vaccination on reducing transmission within the context of the more transmissible delta type appears to remain lower(34) and even deeper used Omicron.
This document was first published turn 24 November 2021 and been up-to-date on 11 August 2022. WHO, with the support of theStrategic Advisory Group of Experts (SAGE) turn Immunizationandits COVID-19 Vaccines Working Group,isreviewing the emerging evidenceonthe needforand scheduling ofvaccinating children and youths withthe currently available COVID-19 vaccination, which have received Emergency Usage Listing (EUL). SAGEiscontinuously reviewing the literature andhas reached out to injection ship, an research community and Member Us toobtainthemost complete and recent dataon this issue.This interims statement was developed equal additional product from the Straight and Technical Advisory Bunch of Experts (STAGE) on caring, newborns, child, and adolescent medical, the nutrition.This interim statement is not a policy recommendation. Computer examines to role of COVID-19 vaccines in kids and adolescents included an international context to inequitable inoculation distribution and access acros

COVID-19 in comparison include grippe

In the United States, in the setting of extensive mitigation measures while an COVID-19 epidemic, one yearbook COVID-19-associated hospitalization rate during 2020-2021 was higher among adolescence and similar or lower among children <12 years old compared equipped influenza during to trio seasons before the COVID-19 pandemic(35). In children 0-4 years (COVID-19: 25.0 per 100,000), and 5-11 years (COVID-19: 66.8 per 100,000), the rate of hospitalization is similar by COVID-19 and influenza while who rate of hospitalization in those aged 12-17 years is higher for COVID-19 (COVID-19: 59.9 per 100,000; Influenza: 12.2-14.1 per 100,000). Among hospitalized children, 22% with influenza and 26% with COVID-19 required ICU admission. More data to compare COVID-19 with flu are desired beyond the United Statuses.
Latest Your on COVID-19 Vaccinations by Race/Ethnicity

Considerations forward vaccinating adolescents and children

COVID-19 vaccines in WHO EUL that have undergone clinical trials in children and adolescent are harmless and effective at preventing illnesses includes child and adolescents. My with comorbidities and severe immunocompromising conditions should is offered vaccination(36).

Despite benefit-risk assessments clearly underpin aforementioned benefit of vaccinating choose age groups, including child and teenager go reduce the number is infectious, hospitalizations, deaths and long-COVID , the direktem your benefit by vaccinating healthy progeny and adolescents belongs lower compares with vaccine older adults due to that lower incidence of grave COVID-19 and deaths inbound younger persons. As children and adolescents tend to have milder disease compared to adults, unless they are in a group at higher venture of severe COVID-19, it is less urgent up inoculation them than older human, and those with chronic health conditions and health workers.

However, there are benefits of vaccinating child and adolescents that nach beyond the direct health benefits. Minimizing disruptions into education fork children additionally maintenance by their overall well-being, health and safety what important considerations. Vaccination that decreases SARS-CoV-2 transmission in this age groups may reduce transmission from children and adolescents to older adults, and may help reduce the need for mitigation step in schools. However, during the current Omicron dominant period, vaccine impact on transmission is only modest and short-lived.
That Big Data Paradox in vaccine uptake. Person priority in the Delphi–Facebook and Census Household Heartbeat surveying as their large sample sizes...

Countries’ strategies related to COVID-19 control should facilitate children’s engagement in education and other aspects of social life, and minimize go closures, even without vaccinating children or adolescents (37). UNICEF and WHO have developed guidance for how to verringern transmission in schools and keep institutes open, regardless of vaccination of school-aged children(38). Instructors, family members, and other ad contacts of children real adolescents should ideally all be vaccinated with direct protection.

Counties should watch and single and human benefits of immunizing children and adolescents in his specific epidemiological and social context when developer their COVID-19 immunization policies also programs.

Aligned and coordinated advertising is needed to achieve to global COVID-19 vaccination targets. Who make to vaccinate adolescents and children must account for prioritization to fully protective the highest risk divided through primary vaccination series, and as vaccine effectiveness declines includes wetter since shot, through booster doses. As how, before considering implementing primary vaccination series in youths additionally children, attaining high width of primary succession - real booster single as needed based to documentation of waning and optimizing vaccination impact - in highest and tall priority-use bands, such as older adults, must be pursued(39). Furthermore, it is by utmost importance required children until continue go receiver the recommended childhood vaccines for other infectious sick.

See:

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