Effects of COVID-19 in children

In Singapore, most children with COVID-19 have either presented without symptoms, or with symptoms of upper respiratory tract infection such as fever, sore throat, runny nose, dry cough; some have experienced a loss of smell and taste.

A small percentage of children in other countries, such as United Kingdom and the United States, have needed intensive care due to COVID-19 complications or multi-system inflammatory disease of childhood (MIS-C) – a multi-system hyperinflammatory syndrome involving the skin, mucous membranes such as mouth and eyes, gastrointestinal tract and cardiovascular organs. While MIS-C has not been reported in children in Singapore, the condition has been reported among Asian countries such as South Korea, India and Pakistan.

 

Benefits of COVID-19 vaccination for children

Although fewer children have been sick with COVID-19 compared to adults, children can become seriously ill from COVID-19 complications and associated long-term health problems, in particular children with underlying medical conditions.

COVID-19 vaccines are effective at preventing children from getting COVID-19 and are effective against currently recognised variants of the virus. Therefore, COVID-19 vaccination can help protect children from becoming infected and having to suffer the effects of the disease. It can also help prevent the child from becoming seriously ill even if they subsequently contract COVID-19.

A vaccinated child becomes less likely to transmit the virus to others, especially those who are more vulnerable e.g. the elderly and persons with weakened immune systems. Having the vaccine may further give parents and children peace of mind to return to activities like in-person schooling and participating in sports.

Overall, the known and potential benefits of COVID-19 vaccination outweigh the known and potential risks of vaccination.

 

Safety of COVID-19 vaccination for children

As at 31 May 2021, real-world data of more than six million vaccinations in adolescents in the United States indicates that the vaccine is safe for children.

Current vaccines that have been approved for use by adolescents have been rigorously tested to be very safe for those aged 12 years and above within the timelines of monitoring within the trials. Since their use, thus far there have not been any reports of adverse events impacting on their development, or causing permanent damage to their cognitive, reproductive or other aspects of health.

All licensed vaccines have been assessed to be safe at a population level, within the timeframes of the monitoring available both within the trials as well as post-licensure. Currently no COVID-19 vaccine whether mRNA or killed whole virus, or protein or subunit vaccines, have long term safety data. Available understanding of the biological mechanisms underlying mRNA vaccines suggest that they should not increase the risk of the child developing any developmental, mental or fertility issues.

 

Eligibility criteria for COVID-19 vaccination in children

Children with the following are currently not eligible for the COVID-19 vaccination:

  • Less than 12 years old
  • An acute illness
  • A transplant in the last three months
  • Known history of allergy to the vaccine components

 

Underlying medical conditions

For children with underlying medical conditions and those receiving chemotherapy for cancer, there should be an informed discussion with their doctor / paediatrician of the risks and benefits based on their individual situation, and a joint decision prior to receiving the vaccination.

 

History of severe allergic reactions

Children with a history of severe allergic reactions / anaphylaxis to other vaccines should be referred to the allergist, before taking the COVID-19 vaccine. Those with a history of allergic reactions including anaphylaxis to food, drugs, insect stings can still receive the vaccine.

 

Underweight and immuno-compromised

Underweight children and those with weakened immune systems, either from illness or medication, may still receive the mRNA vaccine because it is not a live vaccine (i.e. a vaccine that uses a weakened form of a germ to prompt an immune response).

 

Reactions/side effects following COVID-19 vaccination

The Pfizer-BioNTech clinical trial to assess the safety and efficacy of the Pfizer-BioNTech COVID-19 vaccine for children aged between 12 and 15, found that the teenagers had a similar reaction to the vaccine as those of young adults (aged between 16 and 25 years old).

Reactions following the COVID-19 vaccination included fever, fatigue, headache, muscle aches and injection site pain, which generally resolved on their own within a few days. The reactions are due to a robust immune response, indicating that the children are producing good antibodies for protection.

Severe allergic reactions to the COVID-19 vaccine are very rare. To manage the risk of an allergic reaction, vaccine recipients are monitored for 30 minutes after receiving the injection.

 

Scheduled vaccinations for children

There is no need for parents to defer their child's scheduled vaccinations due to the current COVID-19 situation as children may still acquire contagious infections such as measles which will then be detrimental to their health.

Children who have taken their scheduled vaccination (e.g. Human Papillomavirus / HPV) can proceed with the COVID-19 vaccination, as long as there is an interval of two weeks between the administration of these vaccines.

Even if upcoming vaccinations may be missed, there is no need to re-vaccinate the child for vaccinations that they had already received. The vaccination schedule can proceed from the point where it was interrupted as long as the minimum interval period between vaccines / vaccine doses continues to be observed.

 

​Key recommendations for COVID-19 vaccination in children

  • Studies have shown that the COVID-19 vaccines are safe and effective. Clinical trials with sufficient numbers of teenagers and children participating show that the vaccine is safe for those aged 12 years and above.
  • The COVID-19 vaccine is highly effective in preventing symptomatic disease and will also help prevent the child from getting seriously ill even if he/she contracts COVID-19. COVID-19 vaccines are effective against new variants of the virus.
  • Children may have some side effects after their COVID-19 vaccination which are similar to adults. These side effects, which may include injection site pain, fatigue, headache, chills and fever, which will generally resolve on their own within a few days. These are normal signs that the body is building protection (immunity).
  • For children with underlying medical conditions, the child’s doctor/paediatrician should be consulted on the child’s eligibility for the vaccine. Parents are encouraged to speak with their child’s doctor/paediatrician if they have any questions or concerns.
  • Getting vaccinated helps to protect the child from getting infected and passing the disease to others. Being vaccinated gives parents and children peace of mind to return to activities like in-person schooling and participating in sports. The known and potential benefits of COVID-19 vaccination outweigh the known and potential risks of vaccination.
  • There is no need for parents to defer their child's vaccination schedule due to the current COVID-19 situation as children may still acquire contagious infections such as measles which will then be detrimental to their health.

 

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​Associate Professor Thoon Koh Cheng, Head and Senior Consultant, Infectious Disease Service; Senior Consultant, General Paediatrics Service, KKH

Associate Professor Thoon Koh Cheng’s research interests include epidemiology of vaccine-preventable diseases, respiratory viral diseases, antimicrobial stewardship, infection control, adverse events following immunisation.

Associate Professor Chong Chia Yin, Senior Consultant, Infectious Disease Service; Director, Clinical Quality and Patient Safety, Division of Medicine, KKH

Associate Professor Prof Chong’s research interests include vaccine-preventable infectious disease, influenza, pertussis, enterovirus diseases, and infection control. She has authored or co-authored more than 103 research publications. Assoc Prof Chong holds teaching positions at all three medical schools in Singapore. She is currently Adjunct Associate Professor in Paediatrics at Yong Loo Lin School of Medicine, Duke Graduate Medical School and Lee Kong Chian School of Medicine.