LAC DPH COVID-19 Vaccine Update: Vaccinating Children 6 Months of Age and Older July 5, 2022 CDC, Centers for Disease Control and Prevention, clinical trials, COVID-19, epidemiology, immunizations, la county, los angeles county, los angeles department of public health, Moderna, mRNA, myocarditis, pericarditis, Pfizer, provider vaccination hub, public health, United States, vaccination, vaccine for children 1047 Key Messages Children are at risk of and have experienced severe illness from COVID-19. Children of all ages can have short- and long-term health problems from COVID-19. Both Moderna and Pfizer COVID-19 vaccines are now available and recommended for everyone 6 months and older. Everyone should stay up to date with their recommended COVID-19 vaccines (including boosters, if eligible) for the best protection. COVID-19 vaccines and routine childhood immunizations can be given at the same visit. Primary care providers are parents’ and caregivers’ most-trusted source of medical information and guidance and should strongly recommend COVID-19 vaccination for all children. New CDC COVID-19 Vaccine Recommendations for Children The Centers for Disease Control and Prevention (CDC) now recommends COVID-19 vaccination with Pfizer and Moderna vaccines for children 6 months and older. Moderna and Pfizer COVID-19 vaccines for children 6 months-5 years of age The CDC recommends either: Moderna COVID-19 vaccine for children ages 6 months through 5 years of age: Administered as 2 doses, 25 mcg per dose, 4 to 8 weeks apart. Pfizer COVID-19 vaccine for children ages 6 months through 4 years of age: Administered as 3 doses, 3 mcg per dose, with the first two doses 3 to 8 weeks apart, and the third dose at least 8 weeks after the second. As with older age groups, an 8-week interval between first and second dose may be optimal for children who are not immunocompromised as the longer interval may improve vaccine effectiveness and reduce the small risk of myocarditis and/or pericarditis associated with mRNA COVID-19 vaccines. Children who are moderately to severely immunocompromised should receive 3 primary series doses of either Moderna or Pfizer COVID-19 vaccines. See CDC People who are immunocompromised for details. Moderna COVID-19 vaccine for children 6-17 years of age The Moderna COVID-19 vaccine is now recommended for children ages 6 through 17 years. Previously only the Pfizer COVID-19 vaccine was recommended for children ages 17 and under. The Moderna COVID-19 vaccine is administered as 2 doses, 4 to 8 weeks apart. Children 6-11 years: 50 mcg per dose. Adolescents 12-17 years: 100 mcg per dose (same dose as for adults). Note: Supplies of the Moderna vaccine for 6-11 years are expected in LA County by July 7. Updated CDC Clinical Considerations The CDC Use of COVID-19 Vaccines in the United States Interim Clinical Considerations have been updated to include detailed guidance on Pfizer and Moderna COVID-19 vaccines for children 6 months through 17 years. The CDC has also created the following clinical aids: Summary Document for Interim Clinical Considerations Interim COVID-19 Immunization Schedule (includes specific product dosing and descriptions) At-A-Glance COVID-19 Vaccination Schedule (simple 2-page schematic) Moderna COVID-19 Vaccine for Children who Transition from a Younger to Older Age Group Pfizer-BioNTech for Children who Transition from a Younger to Older Age Group Background Young children are at risk of severe illness from COVID-19 and the risk is similar or higher than for other pediatric vaccine preventable diseases. Since January 2020, 202 children ages 6 months to 4 years have died of COVID-19 in the U.S. and COVID-19 is among the top five leading causes of death for children under 5 years of age. Since March 1, 2020, more than two million children ages 6 months to 4 years have been infected with COVID-19. During the winter Omicron wave (December 2021–May 2022), the rate of hospitalization for children ages 6 months to 4 years exceeded the rates of hospitalizations for children ages 5 to 11 years and 12 to 17 years. Overall, more than half of hospitalized children ages 6 months to 4 years had no underlying medical condition. See ACIP slides. The ACIP analysis of efficacy, immunogenicity and safety data from the clinical trials of Moderna (in ages 6 months through 17 years) and Pfizer (in ages 6 months through 4 years) demonstrated that the benefits outweigh the risks for both vaccines in these age groups. The trials did not have enough COVID-19 cases to evaluate efficacy against severe disease, but immunobridging studies showed high antibody levels similar to those of adults after a primary series. Both vaccines are expected to provide better protection against hospitalization and death than protection against infection alone, as is observed in older children and adults. For both the Moderna and Pfizer vaccine clinical trials, local and systemic adverse reactions were mostly mild to moderate and lasted a few days. There were no cases of myocarditis, pericarditis, or vaccine-associated anaphylaxis in any trial participants, though the sample sizes were too small to capture rare events. Based on the epidemiology of classic myocarditis and safety monitoring of myocarditis and pericarditis in children ages 5 to 17 years receiving Pfizer COVID-19 vaccine, myocarditis and pericarditis after COVID-19 vaccination in children is anticipated to be rare. Extending the interval between dose 1 and dose 2 of mRNA COVID-19 vaccines to 8 weeks may further lower myocarditis risk, especially among males ages 12-39. For further details see ACIP slides mRNA COVID-19 vaccine in young children and Moderna COVID-19 vaccine in children and adolescents ages 6-17 years. Full ACIP presentation slide sets can be found on the associated meeting days: Moderna and Pfizer vaccines for young children June 17 | June 18 Moderna vaccine for older children and adolescents June 23 Actions Requested of Providers Healthcare providers are asked to strongly recommend COVID-19 vaccination. Please communicate to patients (and parents/caregivers) that the benefit of COVID-19 vaccines, like other vaccines, is that those vaccinated get protection without risking the potentially serious consequences of getting sick with COVID-19. Vaccinating children can also help relieve the strain on families by providing greater confidence in children participating in childcare, school, and other activities. Actively promote COVID-19 vaccination Contact the parents/caregivers of children 6 months and older and urge them to get their children vaccinated against COVID-19. Encourage them to make sure their children are up to date with their COVID-19 vaccines, including boosters. Please use and share the resources below, which include sample letters and messaging, to promote COVID-19 vaccination of children. If you are not a COVID-19 vaccine provider Enroll in the California COVID-19 Vaccination Program. Parents rely on primary care providers to vaccinate their children, especially those under the age of 3 who cannot be vaccinated in many pharmacies. Please consider becoming a COVID-19 vaccine provider, especially if you serve a pediatric population. Extensive support is available from start-up and beyond. To learn more, please see the flyer Become a COVID-19 Vaccine Provider! Grant funds are available for “Vaccines for Children” (VFC) providers for up to $25,000. The funds may be used to enroll in the COVID-19 vaccine program and to extend hours. For information, visit KidsVaxGrant Refer your patients for COVID-19 vaccination until you are able to provide the vaccine. Advise them to visit ph.lacounty.gov/howtogetvaccinated (English) and ph.lacounty.gov/comovacunarse (Spanish) to search for a vaccination location by zip code, vaccine type, and age. They can also call the DPH Vaccine Call Center 1-833-540-04738am to 8:30pm, 7 days a week if they need help making an appointment, need transportation to a vaccination site, or are homebound. Information is also available in many languages 24/7 by calling 2-1-1. If you are already a COVID-19 vaccine provider Use every clinic visit as an opportunity to vaccinate. Well-child checks, Medi-Cal periodicity screenings, sports physicals, and other clinic visits all serve as opportunities for children to get COVID-19 vaccines as well as routine childhood vaccines that are due or overdue. Ensuring children are up to date with all recommended vaccines is important for when they to return to school this fall. COVID-19 vaccine wastage may occur. Don’t miss an opportunity to offer the COVID-19 vaccine to all eligible children even if it means opening a new vial at the end of the day. Vaccine wastage is to be expected even when providers follow best practices. Consider vaccinating children who are not your patients. If your practice can offer COVID-19 vaccination to children who might not have a medical home, please consider enabling your location to be publicly displayed on vaccines.gov. Promote v-safe, the after-vaccination health checker. Through short, smartphone and/or web -based surveys, parents and caregivers can tell CDC how their children feel after COVID-19 vaccination to help CDC monitor the safety of COVID-19 vaccines in near real time. Hang v-safe posters in your practice, distribute v-safe information sheets, and recommend registering for v-safe during vaccination visits. Note that a parent can sign up themselves and multiple children using the same cell phone number. Resources CDC Resources to promote the COVID-19 vaccine for children & teens, including fact sheets, social media graphics, template newsletters, and links to additional materials in multiple languages. Information for parents and caregivers about COVID-19 vaccines for children and teens, COVID-19 boosters (COVID-19 booster tool) to learn if and when you and your child can get boosters to stay up to date with the COVID-19 vaccines, and 6 Things About the COVID-19 Vaccine for Children. LAC DPH Toolkit: Resources for Communicating with Parents & Children: The toolkit contains COVID-19 vaccine resources for patients (including fact sheets for parents and teens and activity sheets for children) along with provider resources (including sample letters, social media posts, and flyers) to support you when discussing and promoting COVID-19 vaccination to your patients. COVID-19 Vaccine schedules for patients: ph.lacounty.gov/covidvaccineschedules (English) and ph.lacounty.gov/calendariosdevacunasdeCOVID (Spanish). COVID-19 vaccine information for the public: resources available for the public in multiple languages at VaccinateLACounty.com (English) and VacunateLosAngeles.com (Spanish). Visit the LAC DPH Provider COVID-19 Vaccination Hub Refresh your browser to view the latest version. This communication was sent by Dr. Nava Yeganeh, Medical Director, Vaccine Preventable Disease Control Program, Los Angeles County Department of Public Health.