UI Health Care pediatrician and Division Director of Pediatrics and Adolescent Medicine Rami Boutros, MD, and Chief Medical Officer Theresa Brennan, MD, answered questions about authorization of the Pfizer-BioNTech COVID-19 vaccine for children ages 5 and older during a live Q&A on Nov. 4, 2021.  

Below is a summary of the answers provided by Dr. Boutros and Dr. Brennan.

Why should kids be vaccinated against COVID-19, given that the risk of hospitalization and death from COVID-19 is low in children?

It is very important for us to give kids the COVID-19 vaccine because it will help us reach herd immunity. Although the disease is milder in children compared to what we've seen in adults, there is still the potential to have severe disease, as well as the potential to have a severe outcome and even death in younger children. Although it's a small number, it’s still an outcome we’d like to prevent. We know the COVID-19 vaccine is safe and effective for children. 

Giving vaccines to prevent severe disease is not a new phenomenon. We give kids lots of vaccines, including the flu vaccine, for this very reason. The COVID-19 vaccine helps prevent them from getting sick and helps protect the people around the child—parents, siblings, and grandparents. 

Also, the vaccine is very important so that kids can return to their normal lives. We have seen the impact of the pandemic impact on mental health for our teenagers and others. This will allow us to go back to normal and resume the experiences that many of our children have lost during the pandemic. 

What are the most common side effects of the vaccine?

Some of the most common side effects that people can experience with the COVID-19 vaccine include soreness in the arm, redness at the injection site, or a headache. It’s also possible to develop a low-grade fever, chills, or fatigue. Typically, these symptoms are very short lived (less than 48 hours), and the kids bounce back very quickly. 

These side effects are all normal signs that the body is mounting a response to the vaccine, which helps your child’s body to protect itself against the COVID-19 virus. Some people have no side effects at all. 

What does the research say about how effective the COVID-19 vaccine is for this age group?

The vaccine has been shown to be very effective, including against the Delta variant. Clinical trials have shown it to be around 91% effective in preventing COVID disease in children ages 5 through 11. Getting vaccinated reduces the risk of infection, therefore reducing the risk of severe disease, hospitalizations, or long-term COVID-19 complications. The vaccine has also been shown to be very safe. No serious side effects have been detected during the ongoing clinical trial. 

Should kids get the COVID-19 vaccine if they were previously diagnosed with COVID-19 and have recovered?

Yes, kids who had a previous COVID-19 infection should still get the COVID-19 vaccine. We don't know how long the immunity lasts after having the disease, but we do know that kids can get infected a second time. We want kids to be protected for as long as possible. The vaccine is a very important tool to continue to prevent them from bringing the disease back home. 

Across all ages, some of the most recent data suggests that someone who had COVID-19 previously and does not get vaccinated is five times more likely to get COVID-19 a second time compared to someone who does get vaccinated. 

Are there any concerns about possible long-term effects of the vaccine?

Right now, based on the current studies, there is no concern about any long-term side effects. We believe the vaccine is very safe and very effective. These vaccines go through a rigorous review process before they are authorized. The Centers for Disease Control and Prevention, the Food and Drug Administration, and health care providers are watching for side effects. We have not seen any side effects that make us worried about recommending this vaccine. 

Immunization has become safer over the years, with fewer side effects happening. This is because of the rigorous approval process and because health care providers are reporting side effects after the vaccines are released. For the COVID-19 vaccines, we have even more data, because the general public has been able to report side effects. 

Will kids ages 5 to 11 receive the same COVID-19 vaccine that was authorized for older kids and adults?

The only vaccine that has been authorized for kids ages 5 to 11 is the Pfizer-BioNTech COVID-19 vaccine. It is the same vaccine that is available for adults and kids ages 12 and older, but the dosage is different. The vaccine dosage for kids ages 5 to 11 is one-third the dosage that an adult receives. The vaccine dosage for 12- to 17-year-old children is the same as the adult dose. 

There are checks and balances in the system for safety, too. Because the dosage is different, the vaccine for younger kids comes in a different vial. That’s one step to make sure the right dosages are given. Also, we enter it into our electronic system to make sure the dosage is correct. 

Will kids need two doses of this vaccine? What about a booster?

Yes, kids will need a second dose of the COVID-19 vaccine, just like older kids and adults have had. The second dose is given about three weeks after the first dose. 

The first dose does give some immunity, and some antibodies are made. The second dose is really important because it maximizes that immunity so that the child can be best protected. 

As of right now, we don’t know if kids will need to get a booster shot sometime after that second dose. There are studies happening, and we’ll be watching for those recommendations. 

Will kids have to get the second dose at the same location or through the same medical provider?

It’s not required to get the second dose at the same location. The most important part is that your child does get the second dose, wherever that is. Make sure to bring their vaccine card with you when you come for the second dose, so that everything can be recorded accurately.  

After kids are vaccinated against COVID-19, should they still wear a mask?

Yes, we do recommend that kids continue to wear their masks even after they are vaccinated. That may be confusing, but there are a few reasons for this recommendation. First, it does take some time for your body to create the antibodies needed for immunity to develop. It’s not immediate.  

Secondly, no vaccine is 100 percent effective. Even though this vaccine is very good at protecting people from getting an active infection with the virus, it’s not 100 percent effective. Wearing a mask is that secondary barrier to help prevent people from getting COVID-19. 

The third reason is that transmission is high in our community right now. The CDC recommends that everyone, including those who are vaccinated, wear masks in places where there is high transmission of the COVID-19 virus. 

Finally, it protects against other viruses.  Last year at this time, when lots of us were wearing masks in public, we did not see as much influenza in the community. We believe it was because we were all so good at washing our hands and wearing masks. 

This year, as things have relaxed, we’ve seen a lot of RSV in our community. And we’re in the middle of flu season now. So, masks will help keep children protected from all those viruses that are shared in different settings. 

The Pfizer-BioNTech COVID-19 vaccine is an mRNA vaccine. Could you explain what mRNA means and how these vaccines work?

mRNA stands for messenger ribonucleic acid. It's a substance that our cells make every day, lots of times per day, so that those cells in our bodies can make proteins that are needed for the cells to live and function. You can consider it kind of like the code or the translator of how we make the right protein that the cell needs. 

When this vaccine is given to us, the mRNA tells our body to make a protein that actually mimics the spike protein on the COVID-19 virus. When our bodies make the protein, then we make an immune response to the protein in the form of antibodies. It’s been shown to be very effective. 

The messenger RNA contained in the COVID-19 vaccine cannot integrate into your child’s DNA or their human genes and is broken down very quickly once it's exposed in the body. 

The Pfizer-BioNTech COVID-19 vaccine was the first mRNA vaccine available. However, researchers including Stanley Perlman at the University of Iowa, have been studying mRNA vaccines for decades.

More information about mRNA vaccines.

How long should children wait to get vaccinated after they have been exposed or tested positive for COVID-19?

For kids who have been diagnosed with COVID-19, we recommend that they get the vaccine once their symptoms are completely cleared, and they are back to normal. The only reason we would delay giving the vaccine longer would be if the child had received any monoclonal antibodies. But at this time, that treatment is only available to the older kids. 

Does the weight of a child play a role in how the vaccine is administered, or is it only age-based?

As opposed to many medications, vaccine dosages are based on age and not size or weight of the child. If the child is smaller, we may look for an alternative injection site. It may be better for the child to receive the vaccine in the thigh instead of the arm. 

What tips do you have for parents of kids who struggle with fear or anxiety about vaccinations?

The most important thing we recommend to parents is to talk to your child before you bring them in for their vaccine about what to expect. We think trust is an important piece of that. 

Secondly, we are very familiar with offering distraction techniques. This approach helps the children through the process and decreases the pain. It can be as simple as playing a video on a cell phone or tablet or reading a book to them. We also have “Buzzies” that vibrate and help numb the area, so they don’t feel the shot. 

We know vaccines can be tough for kids. We don't want them to feel like they are always coming to the doctor just to get a shot. Preparing them with what to expect gives them the best chance to be comfortable with the process. 

More tips for distraction during vaccines.

Since the dosages are different for 11-year-olds and 12-year-olds, should parents consider waiting to get their child vaccinated if the child will be turning 12 soon?

We recommend that parents of kids who are about to turn 12 go ahead and get the vaccine now. Don’t wait. If you delay the vaccination, you have the risk that the child could be exposed and get sick. 

If a child turns from 11 to 12 years of age in between their first and second dose, the second dose should be the Pfizer-BioNTech vaccine for adolescents and adults. However, if the child receives the Pfizer-BioNTech COVID-19 vaccine for children ages 5 through 11 years for their second dose, they do not need to repeat the dose.  

When do you expect that kids younger than 5 will be eligible to receive the vaccine?

We don’t have a clear answer to that yet. This has been a pandemic of waiting. There are studies going on right now that are looking at children under 5, to evaluate the safety, effectiveness, and proper dosage levels. We hope to see that soon, but we know those experts are going to take their time to make sure that it's a safe and effective vaccine for that age group, just like they have done for the others.