With the more transmissible Omicron variants coupled with the easing of social measures, our children are vulnerable to COVID-19 infections. As it is generally harder for children to comply with hand hygiene and infection control measures, children are susceptible to the infection and can contribute to community COVID-19 transmission to vulnerable persons (e.g. elderly, immunocompromised persons).

Although fewer children have been critically ill with COVID-19 as compared to adults, COVID-19 can still lead to complications in children with the increase in the number of COVID-19 infections nationwide. Complications of COVID-19 include myocarditis, pneumonia, meningoencephalitis and MIS-C (Multisystem Inflammatory Syndrome in Children). Studies have also suggested that children of the lower age group are at increased risk of developing severe COVID-19.

Vaccination reduces the probability of COVID-19 infection and protects the child from developing severe disease, should they be infected. The Infectious Disease Service at KK Women’s and Children’s Hospital (KKH) shares recommendations and special considerations for healthcare professionals.

 
​COVID-19 vaccination for children aged six months to four years
Recommendations​
  • Children aged six months to four years, especially for those with chronic medical conditions, are recommended to complete their primary COVID-19 vaccination series. Children with conditions such as asthma, epilepsy, eczema, or food, drug, dust and environmental allergies are eligible for the vaccine.
  • Moderna/Spikevax COVID-19 vaccine: The primary vaccination series consist of a two-dose regimen of 25mcg each (a quarter of adult dose). The recommended interval for the two doses is eight weeks (56 days).
  • Pfizer-BioNTech/Comirnaty COVID-19 vaccine: The primary vaccination series consist of a three-dose regimen of 3mcg each (one-tenth of adult dose). The recommended interval between each dose will be advised by the Ministry of Health.
  • A 14-day interval between a non-COVID-19 vaccine and COVID-19 vaccine is strongly recommended for this age group, in order to reduce the risk of more side effects from the various vaccines received close to one another.
  • For children who had not completed the COVID-19 vaccination series before being infected with COVID-19, they are recommended to receive a single dose of Moderna/Spikevax COVID-19 vaccine three months after the date of infection to complete the primary vaccination series. With mutation in the virus, a person who had a prior COVID-19 infection can be re-infected. Completion of the vaccination series post infection will maximise the child’s protection against COVID-19.
  • Children are advised to avoid strenuous activities for two weeks post vaccination.
  • Vaccination is recommended even in children who are breastfed by their vaccinated mothers. Vaccination is also recommended for infants who are born to mothers who had been fully vaccinated against COVID-19.​
​Special Considerations
  • ​Parents with children who have the following conditions can consult the child’s paediatrician to discuss the optimal time for COVID-19 vaccination:
    • Primary or acquired immunocompromised conditions
    • Active cancer on chemotherapy, radiation therapy or immunotherapy
    • Children who had undergone organ or haematopoietic stem cell transplant
    • Non-cancer conditions on aggressive immunotherapy
    • History of multisystem inflammatory syndrome in children (MIS-C)
    • Coagulopathy or thrombocytopenia with platelet < 50 x 109/L
​Contraindications
  • Persons with medically confirmed allergic reactions or anaphylaxis to a compound called polyethylene glycol will not be eligible for COVID-19 mRNA vaccines. Information about COVID-19 vaccination is available on www.moh.gov.sg/covid-19/vaccination/child.
  • Persons with allergic reactions or anaphylaxis to a previous dose of mRNA COVID-19 vaccine should not take the same vaccine again. Allergic reactions to mRNA vaccines are uncommon, and this occurs within four hours post vaccination with the manifestation of urticarial and/or angioedema. Anaphylaxis is defined as two or more of the symptoms of hives or face/eyelid/throat/lip swelling, difficulty breathing and dizziness. This usually occurs within one hour post vaccination.
​Safety and efficacy
  • ​There were no reports of serious adverse reactions such as pericarditis, myocarditis and anaphylaxis in the Moderna clinical trial1 where over 6,000 children aged six months to five years were recruited. As of October 2022, more than 1.5 million mRNA vaccine doses have been safely administered to children aged six months to four years in the United States of America. Similarly, no serious adverse reactions had been reported.
  • Data from the clinical trial showed that the common side effects such as fatigue, fever, and injection site pain and swelling were observed less often than in adults. These side effects were generally mild and resolved spontaneously within a few days. The side effect profile of the mRNA COVID-19 vaccine is similar to that of other commonly administered childhood vaccines.
  • A child cannot be infected with COVID-19 from the vaccine, as the mRNA vaccine is not a live vaccine.
​Resources
​Parents/guardians need to register their interest for their child to receive the vaccination at child.vaccine.gov.sg. An SMS with a personalised booking link will be sent to the registered mobile number of the parent/guardian to book a vaccination appointment at a vaccination centre (VC) or selected polyclinics.
​References
  1. ​Anderson EJ, Creech CB, Berthaud V, et al. Evaluation of mRNA-1273 Vaccine in Children 6 Months to 5 Years of Age. N Engl J Med. 2022;387(18):1673-1687.
  2. Child vaccination. Ministry of Health. (2022). Retrieved November 7, 2022, from https://www.moh.gov.sg/covid-19/vaccination/child
  3. FAQs - child vaccination. Ministry of Health. (2022). Retrieved November 7, 2022, from https://www.moh.gov.sg/covid-19/vaccination/child/faqs---child-vaccination
  4. Health Sciences Authority. (2022, August 24). HSA extends the use of Spikevax covid-19 vaccine by Moderna to the younger population aged 6 months to 17 years old. HSA. Retrieved November 7, 2022, from https://www.hsa.gov.sg/announcements/press-release/hsa-interimauth-spikevax6mth-17yo
  5. Health Sciences Authority. (2022, September 29). HSA authorises the use of Comirnaty covid-19 vaccine by pfizer in young children aged 6 months through 4 years. HSA. Retrieved November 7, 2022, from https://www.hsa.gov.sg/announcements/press-release/hsa-auth-comirnaty6mth-4y