Vaccination for pre-existing small children: what does the STIKO recommendation mean?

According to the Standing Vaccination Commission, small children with previous illnesses should be vaccinated against Corona. Who exactly is affected? And can healthy small children also be vaccinated?

In mid-October, the EU medicines agency EMA recommended that the corona vaccines also be approved for babies and toddlers aged six months up to and including four years. The Standing Vaccination Commission (STIKO) in Germany has now recommended a corona vaccination for this age group for the first time, following the advice of the EMA. However, the vaccination recommendation only applies to children from risk groups.

For which children does the recommendation apply?

The vaccination recommendation is aimed, among other things, at children who were born too early. As with older children and adults, various previous illnesses also play a role in assessing the risk of severe Covid-19 disease.

dr Martin Terhardt, STIKO member and pediatrician, explains that around ten percent of all small children belong to a risk group. While asthma and diabetes tend to be less important in this age group, children with diseases that affect the nerves or muscles are particularly at risk, the pediatrician says.

This contains a list of all relevant underlying diseases in children and adolescents aged six months to 17 years who are at increased risk of severe Covid 19 courses current Epidemiological Bulletin of the Robert Koch Institute.

What vaccines are recommended?

The recommendation of the STIKO experts is based on the recommendation of the EMA. Not all of the available vaccines are approved for young children. Primary immunization with an mRNA vaccine is recommended. Preferably, the vaccine from BioNTech/Pfizer (Comirnaty) should be vaccinated, alternatively with the vaccine Spikevax from Moderna. There are currently delivery problems with Spikevax, which is why STIKO primarily relies on vaccinations with Comirnaty.

However, both vaccine candidates are not yet adapted to new virus variants, they are based on the wild type of the virus. The STIKO sees no problem in this regard, since a significantly better protective effect through adapted vaccines has not yet been proven.

The BioNTech/Pfizer vaccine will be given to children at a lower dose than adults. They only receive a tenth of the dose, but are vaccinated three times. As the Science Media Center states in a statement, the first two doses should be administered three weeks apart, and finally the third at least eight weeks after the second dose.

Will the vaccination also be recommended for small children without previous illnesses in the future?

If more data from vaccination studies become available in the future, the recommendation of the STIKO could be adjusted. Other preparations from other manufacturers could then also come into question. So far, however, the STIKO recommendation has only been aimed at small children with previous illnesses. According to the STIKO, there is hardly any risk of a severe course of Covid for children without a previous illness. It should also be noted that the immune system of small children is significantly less developed than that of adults, explains pediatrician Terhardt.

It could work out like the vaccination recommendation for 12 to 17-year-olds: Initially, the recommendation only applied to children who were particularly at risk, and later to everyone.

Does vaccinating young children also protect others?

STIKO has also dealt with the question of so-called third-party protection. So the question of whether young children should be vaccinated to protect vulnerable people in their environment. According to the STIKO, this is not necessary. Pediatrician Terhardt explains the decision by saying that the additional protective effect on the risk group is very low. The STIKO had previously recommended full vaccination for third-party protection for children aged 5 to 11 – this recommendation is now being put into perspective for this age group. In the future, STIKO will recommend individual consideration, taking into account the wishes of the parents.

Can I have my child vaccinated without a STIKO recommendation?

Basically, there is no general vaccination ban for children from six months to five years. If you would like to have your child vaccinated against Corona, you can do so in consultation with your pediatrician.

The initially limited vaccination recommendation of the STIKO does not mean that the vaccine is classified as harmful for children without a risk disease. It is always a question of an individual weighing up of benefit and risk by the parents. dr Robin Kobbe, specialist in child and adolescent medicine, emphasizes tagesschau24that the risk of a serious illness, even if it is already very low, can be further reduced by vaccination.

The recommendation also helps paediatricians, explains the specialist. Because the official vaccination recommendation gives you security. From now on, vaccination of young children is no longer an off-label use – that would be a non-recommended use of the vaccine.