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Last week, the US Centers for Disease Control and Prevention issued guidance recommending the updated Covid-19 booster shot for children ages 5 to 11. Previously, the bivalent booster vaccination was recommended for children from the age of 12 and for all adults. Now the Pfizer/BioNTech booster is available for children aged 5+ and the Moderna booster can be given to children aged 6+.
What should parents consider when deciding whether to get the updated booster vaccine for their children? Are there circumstances that might cause families to wait? Are there any disadvantages? What about kids who just turned 5 – should they get the new booster shot? If a child has not yet been vaccinated, is he/she entitled to the updated booster shot?
To guide us through these questions, I spoke with CNN Medical Analyst Dr. Leana Wen, an emergency physician and professor of health policy and management in the School of Public Health at George Washington University’s Milken Institute. She is also the author of Lifelines: A Doctor’s Journey in the Fight for Public Health and a mother of two young children.
CNN: Who is now eligible to receive the updated Covid-19 booster? Does it matter how many vaccines they have previously received?
dr Leana Wen: In principle, anyone over the age of 5 can receive the new bivalent Covid-19 booster as long as they have completed their basic vaccination series. It doesn’t matter how many boosters they got. This means that a child who has only received the first two doses of either Pfizer or Moderna can receive the booster, as can a child who has already received a booster dose, provided it has been at least two months since their last dose of vaccine.
CNN: What should parents and caregivers consider before deciding on the updated booster shot for their children?
Whom: There are two key questions to ask. Firstly, is your child at high risk of serious illness due to Covid-19? The number one reason to get vaccinated is to reduce the chance of hospitalization and other serious consequences. The first two doses of the vaccine can do this very well for most children. However, some may still be at greater risk of worse outcomes — for example, if a child has serious underlying conditions, is receiving chemotherapy, or is a transplant recipient. Under these circumstances, a booster vaccination would be advisable.
Secondly, is it very important to you to avoid covid-19 infection in your children? Many families have decided that after their children have been vaccinated, when the risk of serious illness is very low, they will not prioritize eliminating Covid-19 infection.
On the other hand, others remain very alert and cautious. Perhaps they are concerned about the unknowns surrounding Long Covid. They may want to avoid their children getting sick, which leads to missed school days and work days for caregivers. Or maybe there is another household member to protect, e.g. B. an older grandparent or another person with chronic underlying diseases. All of these are sensible considerations to get kids the booster sooner rather than later.
One thing I would like to point out is that we do not know how long the booster shot will be effective in reducing symptomatic infection. Some studies have shown that the effectiveness of the primary vaccine against symptomatic infections can decrease within a few months. However, a lot can happen with Covid-19. We have seen rising falls this fall and winter. There could be a new variant that becomes dominant. Many parents want to keep their children as safe as possible in the event of another rise, and then decide again next year if another refresher is needed.
CNN: Are there any circumstances that might cause families to delay fostering their children?
Whom: If a child has just had Covid-19, I think it’s wise to wait at least three months, as the CDC recommends, before doing a booster. Reinfection is unlikely during this period and it may be beneficial to give the body time to develop its own immune response.
The same applies to a previous vaccination. The CDC says children and adults can get the updated booster shot as long as it’s been at least two months since their last shot.
I think these are both minimum distances. Many experts, including myself, believe there are benefits in waiting longer—maybe four to six months—after infection or the last vaccination. This longer period may allow the body to develop enhanced immunity before another boost, some studies have suggested. However, I also understand and appreciate the need for the CDC to have streamlined guidance, and it is sensible to follow their guidelines as directed.
CNN: Is there any downside to giving the booster to kids?
Whom: This is an important question. I would answer to clarify that every intervention – including vaccines – has advantages and potential disadvantages. Parents and families will weigh the pros and cons differently. The evidence is very clear that with the first vaccines, the benefits far outweigh any potential risk. For boosters, the evidence is less clear.
For example, in the case of a child with serious underlying conditions, the booster has a significant benefit in preventing serious consequences due to Covid-19. For other children, particularly younger children under 12, the initial vaccines are likely still very protective and it is not yet clear what the added benefit of the booster dose is in reducing the risk of hospitalization.
There are some common side effects of Covid-19 vaccines. The vast majority are benign and resolve on their own; Symptoms such as body aches, fatigue, fever, and soreness at the site of the booster usually go away after a few days. (There are very rare cases of myocarditis, an inflammation of the heart muscle that occurs most commonly in adolescent males. Again, these tend to go away on their own and cause no long-term effects.) In general, this shouldn’t be an important consideration for the parents.
The CDC recommended the refresher, and I think it’s reasonable for parents who want to follow the guidance. For those who are undecided, having an open discussion with your pediatrician about your family’s unique circumstances can help guide your decision.
CNN: What about kids who just turned 5 — should they get the new refresher?
Whom: I have a son who recently turned 5 and got his first set when he was 4. His last injection was in July. I don’t intend to give him the refresher yet. I’m waiting at least six months for the above reasons.
CNN: Can parents and caregivers give their kids a dose of the original booster?
Whom: no The US Food and Drug Administration has withdrawn its approval for the original monovalent vaccine and replaced it with the updated bivalent booster vaccine. That means you can only get the updated booster. This applies to children as well as to adults.
CNN: If a child has not yet been vaccinated, is they eligible for the updated booster shot?
Whom: no Children who have not yet been vaccinated can only receive the original vaccine for their primary immunization. Parents who want their children to receive the updated bivalent vaccine must complete the primary series – two doses of Pfizer or Moderna – and then receive the updated booster.
I want to emphasize the importance of the primary series. Numerous studies have shown that the first two doses offer a high level of protection against serious diseases, including in children. In a New England Journal of Medicine study, the first two doses of either the Pfizer or Moderna vaccines reduced hospitalizations in children by more than 80%. This should be a call to action for families who have not yet given their children Covid-19 vaccines to enable them to be vaccinated for the first time.
