With Covid Vaccines for Teens and Kids, Timing Matters

Greg Gold, a high school senior from Westchester County, N.Y., went to the doctor for a checkup last week. His pediatrician, Dr. Jane Guttenberg, had planned to give him his meningococcal B shot, which she wanted him to get before he goes to college this fall. But when Dr. Guttenberg heard that he had an appointment for his first Covid-19 vaccination the next day, she told him they would hold off on the meningococcal vaccine until after he was fully vaccinated against Covid-19.

According to current recommendations from the Centers for Disease Control and Prevention, you aren’t supposed to get any other vaccine for two weeks before or after a Covid vaccine. That means that Mr. Gold, 17, will wait until mid-June to start the meningococcal B sequence — two shots, a month apart. He’ll still have time to get it done before he heads to Vanderbilt University in the fall, but the scheduling and juggling came as something of a surprise to him and his mother.

Dr. Guttenberg, who practices in New York City and in Scarsdale, N.Y. (and at Bellevue Hospital where she is one of my colleagues), said, “I’m prioritizing the Covid vaccine for all these kids going to college.”

Anyone with a teenager who is up against a deadline to be vaccinated for fall — or for camp this summer — should remember that vaccines have to be spaced, which can mean a seven- or eight-week window around Covid vaccines when other shots can’t be given.

Dr. Lee Beers, a professor of pediatrics at Children’s National Hospital who is the president of the American Academy of Pediatrics, said, “We’re really trying to push the message, get in and see your pediatrician and get caught up on your routine vaccines now or you’re going to end up in this really tricky place and have to delay Covid vaccine or other vaccines.”

With the news Monday that the Food and Drug Administration is preparing to authorize use of the Pfizer-BioNTech Covid-19 vaccine in children 12 to 15 years old by early next week, parents will need to plan with their pediatricians how to coordinate those along with catching up on their other shots. And younger children who have other shots due might want to consider catching up right now, so that they’re fully up-to-date for sports, camp or school. That way, as soon as they are eligible for Covid vaccines, there won’t be so much juggling to be done.

And a lot of kids have catching up to do, said Dr. Bonnie Maldonado, a professor of global health and infectious diseases at Stanford who is the chair of the A.A.P. committee on infectious diseases. When it comes to immunization, she said, “We lost a lot of ground in the pandemic, and the biggest gaps are in the adolescent age group.”

The regular vaccination schedule is determined primarily by burden of disease, said Dr. James Campbell, a professor of pediatric infectious diseases at the University of Maryland School of Medicine who is the chairman of the American Academy of Pediatrics subcommittee on vaccinations. You want peak protection at the age of peak risk, he said.

Dr. Campbell pointed out that for all the stories about vaccine hesitancy, only 1 percent of the parents in the United States actually choose not to vaccinate their children at all — and that he believes the publicity drumbeat of the Covid vaccination campaign will ultimately leave parents more comfortable, not less.

“In the end, this will be very good for vaccines that so much emphasis has been put on the process and the safety and the review,” Dr. Campbell said.

“In the past, I think people didn’t realize just how much scrutiny there is,” of serious reactions to any vaccine, Dr. Campbell said, or how much attention is paid to schedule, dose, and immune response when a new vaccine is tested.

When it comes to the Covid vaccines, Dr. Maldonado said, “We’re not overly specifically concerned about anything with this vaccine, we’re just following the normal processes.”

Still, it’s possible that younger children, who typically have more robust immune systems than adults, may react more strongly to the Covid vaccines. That is why vaccine studies in children look carefully at dosage and immunologic reactivity, Dr. Beers said: “They often start with a smaller group, give a lower dose of vaccine, test the response, work their way up to the dose needed for adequate immunity.”

Dr. Campbell and his colleagues at Maryland are just starting their first study of Covid vaccine in children under 12. And no one, he said, should be trying to convince parents that the vaccines are safe and effective in this age group until the data are available: “I have no reason to believe they won’t be safe and effective, but the proof is in the pudding — I want to see the pudding.”

Getting children caught up on their regular vaccines makes sense because it will keep them well protected if other diseases flare up now that the pandemic has driven down the rates of the usual childhood immunizations. Doctors are worried about a whole list of vaccine-preventable diseases, including measles, whooping cough, meningitis, HPV and flu.

Will Covid vaccines eventually fit into the schedule of routine childhood immunizations, and if so, at what age? Because the new vaccines are still in an emergency use authorization phase, “Nobody has answers; we’ll have to see over time,” Dr. Maldonado said.

For some diseases, it’s possible to vaccinate children for lifelong protection. Sometimes you wait to vaccinate until you reach the age when risk is higher. For example, we give HPV vaccine to children sometime between 9 and 12, so they will be immune before they become sexually active. We time the meningococcal vaccine for that age because the disease is more common in teenagers and young adults than in elementary school children.

Other diseases are most dangerous to infants or young children, so you need to vaccinate in infancy — such as rotavirus, which can cause severe dehydrating diarrhea in infants and small children, or whooping cough. Covid-19 is a disease that tends to be less severe in children, but which has still caused a great deal of serious illness. “We appreciate the fact that children are less at risk, but take seriously that they can get quite ill, that they can have long-haul symptoms or MIS-C,” Dr. Beers said, referring to the rare but serious Covid-related inflammatory condition in children.

And in addition to protecting children, immunizing them against Covid-19 may protect the adults around them; Dr. Campbell said that having pneumococcal vaccine in the infant schedule had meant not only a major reduction in disease for children, but also a drop disease in older adults who have contact with kids who are immunized.

Many families are waiting eagerly for vaccines to be available for their under-16 children. And many 16- to 18-year-olds are as eager to be vaccinated as their pediatricians are to see them get their shots. Mr. Gold, who, along with his whole family, had Covid-19 in March, was happy to be able to keep his vaccine appointment, and to come back in June for his first meningococcal B shot, and happy that there was time to get it all done before the fall.

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