So far, the Standing Vaccination Committee (Stiko) has been reluctant when it comes to the corona vaccination of five to eleven year olds. She only officially advised children with underlying diseases or particularly vulnerable relatives to have an injection. Now she recommends that all children in this age group be vaccinated with the Biontech vaccine, and if desired also with the Moderna vaccine. What is unusual about the current decision is that the Stiko initially only provides one vaccination dose for all healthy children – and leaves open whether a refresher should be added later.
The vaccination committee hopes that this changed strategy will help the children build up basic immunity, which should also protect against any new virus variants or subtypes. At the same time, the rare severe course of Covid-19 should be prevented and indirect consequences of infection such as isolation and quarantine phases should be reduced. The new recommendation is about “precautionary measures for upcoming waves of infection that are not yet known to us,” explained pediatrician and Stiko member Martin Terhardt at an event hosted by the German Science Media Center. Reinhard Berner, director of the children’s clinic at the Dresden University Hospital, who is also a member of Stiko, put it this way: “We dare to look into the future and want to prepare children in their third Corona winter so that they get through this time as safely as possible .”
The two Stiko members justified the decision for initially only one dose with the fact that a very large proportion of five to eleven year olds may have already gone through an infection – and therefore already have a certain level of immune protection. According to the reporting data from the Robert Koch Institute, almost half of all children in this age group have already been infected with Sars-CoV-2. In addition, there is a significant number of unreported cases, so that a rate of infections passed of more than 80 percent is possible, it is said in the scientific justification of the panel.
With the vaccination, the immune protection that already exists in many children can be strengthened again. It has been observed that children who are vaccinated after an infection react with a very strong antibody response, said Tim Niehues, chief physician at the Center for Pediatric and Adolescent Medicine at the Helios Clinic in Krefeld. It is therefore assumed that this combination leads to better immunity than infection or vaccination alone. However, the doctor qualified that this special model has not yet been tested in randomized clinical studies. The findings came from antibody measurements and observational studies in other age groups.
Serious side effects have been reported very rarely
The fact that Stiko gave up its reluctance to vaccinate children is mainly due to the fact that knowledge about the safety of the vaccine has improved. The myocarditis observed in adolescents and young adults as a result of the vaccinations is “very small” in younger people, says Terhardt. There is no proven case in Germany. According to the Stiko, severe side effects have been reported in various countries – including Germany – in one in 100,000 vaccinated children.
Nothing has changed in the assessment of the risk of serious Covid diseases in this age group; the risk for children in good basic health is still considered to be low. Less than one in 10,000 healthy children between the ages of five and eleven require hospital treatment for Covid-19, the statement said. However, the assessment took into account that with omicron a much more contagious variant now dominates, which is why further waves of infection are to be expected.
A possible second dose should be decided in late summer or autumn. Criteria are the infection process, the then predominant variants, the duration of the immunity acquired up to that point and the effectiveness of the vaccines then available. It is possible that a vaccine adapted to newer variants will then already be available, said Terhardt. It is also possible that there is no recommendation for the second injection. “If Omikron continues to determine the game, I don’t see why we should give a second vaccination in the fall,” said Berner. In this case, no great additional benefit can be expected from a refresher with the currently available vaccines.
The vaccination protection against omicron infections in younger children without a previous illness is about 30 to 60 percent, said Terhardt. The protection against serious illnesses is higher, but most children in this age group would not have to expect any serious courses anyway.
The old recommendation still applies to children with underlying diseases who are at higher risk of developing severe Covid diseases. You should get a total of three vaccine doses. Children receiving the vaccine to help protect a vulnerable family member should receive two doses as before.
The vaccination can be used immediately. If the child has already had an infection, three months should elapse before vaccination. If the infection has gone through unnoticed and the interval is less than three months, the experts do not assume a risk. In this case, however, it could be that the immune protection is less good.
Before that, five to eleven-year-olds could get the vaccination on a voluntary basis. So far, 22 percent have accepted the offer. With the current recommendation, the Stiko hopes more families will opt for protection. It remains to be seen whether the lack of clarity about how to proceed from autumn and the different recommendations in different age groups will affect acceptance. Terhardt pointed out that the current situation was “a very new and exhausting experience” for Stiko as well. Nevertheless, you have to remain flexible in a pandemic: “We have to make decisions from month to month.”