ArticleLiterature Review

Should children be vaccinated against COVID-19?

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Abstract

Whether all children under 12 years of age should be vaccinated against COVID-19 remains an ongoing debate. The relatively low risk posed by acute COVID-19 in children, and uncertainty about the relative harms from vaccination and disease mean that the balance of risk and benefit of vaccination in this age group is more complex. One of the key arguments for vaccinating healthy children is to protect them from long-term consequences. Other considerations include population-level factors, such as reducing community transmission, vaccine supply, cost, and the avoidance of quarantine, school closures and other lockdown measures. The emergence of new variants of concern necessitates continual re-evaluation of the risks and benefits. In this review, we do not argue for or against vaccinating children against COVID-19 but rather outline the points to consider and highlight the complexity of policy decisions on COVID-19 vaccination in this age group.

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... Vaccination has been one of the cornerstones of the public health response to COVID-19. However, there has been some debate over the need to vaccinate children due to the relatively lower severity of infection [1]. In the UK, vaccination has been available for those aged 16 years and above since December 2020, but was subsequently extended to younger age groups (see Box 1). ...
... UK data from a multi-country survey found that 64% of women who were pregnant or had one child aged 18 years or under were likely to vaccinate their child (data collected 28 October to 18 November 2020) [26]. The discrepancy between these findings and our results may be because of the increased debate surrounding child COVID-19 vaccination [1], and decreased perceived risk of COVID-19 between January and October 2021 [28], itself associated with vaccination intention [20]. ...
... As the UK's response to the pandemic shifts to "living with COVID-19," this strategy is in part relying on adult vaccination as a means of reducing serious infection in the absence of other non-pharmaceutical interventions (testing, self-isolation, wearing a face covering, limits on social mixing) [49]. The risks and benefits of vaccination to children have been more balanced [17], leading to greater debate about whether children should be vaccinated [1]. Parents need to be able to make an informed decision as to whether they vaccinate their child. ...
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Aim: To investigate UK parents' vaccination intention at a time when COVID-19 vaccination was available to some children. Methods: Data reported are from the second wave of a prospective cohort study. We conducted a mixed-methods study using an online survey of 270 UK parents (conducted 4-15 October 2021). At this time, vaccination was available to 16- and 17-year-olds and had become available to 12- to 15-year-olds two weeks prior. We asked participants whose child had not yet been vaccinated how likely they were to vaccinate their child for COVID-19. Linear regression analyses were used to investigate factors associated with intention (quantitative component). Parents were also asked for their main reasons behind vaccination intention. Open-ended responses were analysed using content analysis (qualitative component). Results: Parental vaccination intention was mixed (likely: 39.3%, 95% CI 32.8%, 45.7%; uncertain: 33.9%, 95% CI 27.7%, 40.2%; unlikely: 26.8%, 95% CI 20.9%, 32.6%). Intention was associated with: parental COVID-19 vaccination status; greater perceived necessity and social norms regarding COVID-19 vaccination; greater COVID-19 threat appraisal; and lower vaccine safety and novelty concerns. In those who intended to vaccinate their child, the main reasons for doing so were to protect the child and others. In those who did not intend to vaccinate their child, the main reason was safety concerns. Conclusions: Parent COVID-19 vaccination status and psychological factors explained a large percentage of the variance in vaccination intention for one's child. Further study is needed to see whether parents' intention to vaccinate their child is affected by fluctuating infection rates, more children being vaccinated, and the UK's reliance on vaccination as a strategy to live with COVID-19.
... 20 If the disease in the pediatric population is not controlled, children may become a reservoir of the virus, leading to epidemics in the community. [21][22][23] With the shared effort of government authorities, pharmaceutical companies, and the scientific community, a number of Covid-19 vaccines have been widely used in the adult population. Children and adolescents, as a special population, were generally excluded from the initial clinical trials and, therefore, the vaccination was introduced later in this group. ...
... 27 Moreover, unfortunately, inequalities in the distribution of vaccines, vaccine hesitancy, misinformation, and political complexities, make vaccination coverage insufficient to contain the pandemic. 21 Immunogenicity of vaccines against Covid-19 in the pediatric population Overall, evidence of good immunogenicity has been observed for vaccines against Covid-19 in children. In most studies, comparable humoral antibody responses were observed regarding neutralizing antibody titers in children and adults. ...
... It has been shown that people with a previous history of Covid-19 have enhanced immune responses when vaccinated, concluding that, in this situation, having had the disease and subsequently being vaccinated, is the combination that would result in a more robust immune response. 21 In the presence of mild to moderate SARS-Cov-2 infection, the Covid-19 vaccine can be administered four weeks after the infection. When the condition is severe (including MIS-C), the Covid-19 vaccine should be administered three months after the resolution of the condition, after assessing the individual's health conditions. ...
Article
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Objective Covid-19 had a direct impact on children's health. The aim of this review was to analyze epidemiological and clinical data, the consequences of the pandemic, and vaccination aspects in this group. Sources of data The searches were carried out from January 2020 to November 2022, in the MEDLINE databases (PubMed) and publications of the Brazilian Ministry of Health and the Brazilian Society of Pediatrics. Summary of findings Covid-19 has a mild presentation in most children; however, the infection can progress to the severe form and, in some cases, to MIS-C. The prevalence of the so-called long Covid in children was 25.24%. Moreover, several indirect impacts occurred on the health of children and adolescents. Vaccination played a crucial role in enabling the reduction of severe disease and mortality rates. Children and adolescents, as a special population, were excluded from the initial clinical trials and, therefore, vaccination was introduced later in this group. Despite its importance, there have been difficulties in the efficient implementation of vaccination in the pediatric population. The CoronaVac vaccines are authorized in Brazil for children over three years of age and the pediatric presentations of the Pfizer vaccine have shown significant effectiveness and safety. Conclusions Covid-19 in the pediatric age group was responsible for the illness and deaths of a significant number of children. For successful immunization, major barriers have to be overcome. Real-world data on the safety and efficacy of several pediatric vaccines is emphasized, and the authors need a uniform message about the importance of immunization for all children.
... Among all the articles, 7 articles (30,31,40,52,59,70,77) were highlighting all adverse events as major events related with COVID vaccination, whereas 14 articles (19,21,22,24,26,27,32,35,39,42,51,60,73,74) focusing all those events as minor or rare events; 10 articles (16, 17, 33, 41-43, 56, 57, 66, 69) were reflecting in a neutral tone about adverse events following COVID vaccination. Myocarditis (6 articles) (16,17,24,31,42,58), pericarditis (6 articles) (16,17,24,31,42,58). Chest pain (3 articles) [17,21,254], Fever (2 articles) (17,21), Myalgia (2 articles) (17,21), fatigue (2 articles) (17,21), cerebral venous thrombosis (2 articles) (16,17), MIS-C (2 articles) (16,17), and headache, decreased left ventricular ejection, dysrhythmia, Vaccine-induced thrombocytopenia (VITT), Pediatric nephrotic syndrome, sore throat, and neck pain were reported by one article each. ...
... Among all the articles, 7 articles (30,31,40,52,59,70,77) were highlighting all adverse events as major events related with COVID vaccination, whereas 14 articles (19,21,22,24,26,27,32,35,39,42,51,60,73,74) focusing all those events as minor or rare events; 10 articles (16, 17, 33, 41-43, 56, 57, 66, 69) were reflecting in a neutral tone about adverse events following COVID vaccination. Myocarditis (6 articles) (16,17,24,31,42,58), pericarditis (6 articles) (16,17,24,31,42,58). Chest pain (3 articles) [17,21,254], Fever (2 articles) (17,21), Myalgia (2 articles) (17,21), fatigue (2 articles) (17,21), cerebral venous thrombosis (2 articles) (16,17), MIS-C (2 articles) (16,17), and headache, decreased left ventricular ejection, dysrhythmia, Vaccine-induced thrombocytopenia (VITT), Pediatric nephrotic syndrome, sore throat, and neck pain were reported by one article each. ...
... Myocarditis (6 articles) (16,17,24,31,42,58), pericarditis (6 articles) (16,17,24,31,42,58). Chest pain (3 articles) [17,21,254], Fever (2 articles) (17,21), Myalgia (2 articles) (17,21), fatigue (2 articles) (17,21), cerebral venous thrombosis (2 articles) (16,17), MIS-C (2 articles) (16,17), and headache, decreased left ventricular ejection, dysrhythmia, Vaccine-induced thrombocytopenia (VITT), Pediatric nephrotic syndrome, sore throat, and neck pain were reported by one article each. Myocarditis, which was reported and verified in 1,626 cases in the USA, was the most frequent adverse event associated with the COVID-19 vaccination in the 16-to 24-year-old age group (December 2020 to August 2021) (87). ...
Article
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It is still debatable whether all children should receive the COVID-19 vaccine. The comparatively mild cases and low risk of COVID-19 in children compared to adults, as well as the lack of clarity on the relative effects of the disease and vaccine, indicate that the risk-benefit ratio of vaccination in children is more nuanced. To consider and highlight the complexity of policy decisions regarding COVID-19 vaccination in children, we outlined the points regarding for and against vaccination of children against COVID-19 in this systemic review. Using Medical Search Headings (MeSH) terms and keywords, we searched PubMed, PubMed Central, Scopus, and Google Scholar. The primary search term was COVID-19 vaccination (all synonyms), factors (all synonyms), and among children (all synonyms). A total of 367 articles were searched. Finally, 64 articles met the inclusion criteria and were included in the review. The major theme/tone of 28 (43.75%) articles was in favor of children's COVID vaccination, and they were highlighting the positive factors, whereas the major theme/tone of 20 (31.25%) articles was against it. Approximately 16 (25.0%) articles were in a neutral position. Major factors highlighted by articles in favor of childhood COVID vaccination were as follows: the increasing rate of disease burden (29 articles), prevention of interruption of academic activities of children or school reopening (24 articles), and a role in defense against COVID infection (21 articles). Major factors against childhood vaccination were as follows: mild infection among children (27 articles), ethical concerns and legal problems regarding the consent of minors (17 articles), and vaccine hesitancy among parents for childhood vaccination (11 articles). Whereas, factors of uncertainty were the role in the reduction of community transmission (19 articles), protection against MIS-C (10 articles), and defense against long COVID (7 articles). Considering all the factors of COVID-19 disease progression among children, a cautious approach will be essential before proceeding with COVID-19 vaccination in children.
... Total, n(%) Intention, n(%), 646 (56) No intention, n(%), 508 (44 against COVID-19, based on a previous study, it has proven to be a problematic issue among parents; fueled by their health beliefs, perceptions and strategies towards their children [23]. ...
... Nonetheless, the issue of vaccination in children among parents is also affected by the need to return to normalcy, which is consistent with the findings of previous studies [55,56]. For parents with children, part of the normalcy which they desire is for children to go back to attending school physically. ...
... Therefore, the parents who are reluctant to have their children vaccinated have indicated that in the event that their children's school requires mandatory vaccination, they would have their children vaccinated. Therefore, if the schools leave vaccination as an optional requirement lesser children would be vaccinated but if it were mandatory more children would be vaccinated, which is consistent with the findings of Zimmerman et al., 2021 [56]. This indicates some of the conditions which have the potential to change the intentions of the parents towards their children's vaccination. ...
Article
Background The issue around vaccination of children has brought divergent opinions among the populations across the globe and among the Arab population. There has been a low response rate to the calls for vaccination of children and this is reflective of the sentiments which parents may have towards their children being vaccinated. This study aims to explore the parents’ health beliefs, intentions, and strategies towards the COVID-19 vaccine for their children among Arab population. Methods A cross-sectional study using an online survey from October-December 2021, was carried out in five Arab countries in the Middle East. A reliable health belief model (HBM) including five domains: severity, susceptibility, benefits, barriers and cues to action, was adopted. Chi-square, Mann–Whitney test, and multivariable logistic regression were performed for data analysis. Results The survey response rate was 58% (1154/2000). Only 56% of Arab parents are intended to vaccinate their children against COVID-19. The mean scores of parental health belief are largely driven by their concern over the vaccine’s side effect (p=0.001) followed by its efficacy, safety (p<0.001), and scheduling difficulty (p=0.029). However, strategies that were statistically encouraged parents to vaccinate their children included doctor’s recommendation, adequate information being provided, and acceptance of the vaccine by public (p<0.001). Parents with one child were almost three times most likely to vaccinate their children (OR=2.660, 95%CI=1.572-4.504, p<0.001). Parents' desire to vaccinate their children is also influenced by other factors such as job loss owing to COVID-19 and the presence of a health worker in the family. Conclusion Intention of Arab parents to vaccinate their children via COVID-19 vaccine is still limited. Thus, it is essential for health care authorities to avail the information which will debunk the erroneous beliefs which some parents have developed towards the vaccination of children against COVID-19.
... While only a small proportion of children who have COVID-19 will go on to have severe disease, the widespread prevalence of COVID-19 in this population means the absolute number is still large, including those at risk of sequential severe outcomes, particularly 'Long COVID' (23) or Multisystem Inflammatory Syndrome in Children (MISC-C) (24)(25)(26)(27)(28)(29)(30)(31)(32)(33). Symptomatic or asymptomatic children may infect their parents or other vulnerable people with COVID-19 (34)(35)(36). Furthermore, children have been affected by disruptions to day care, school and extracurricular activities, as well as the economic and mental health impacts of COVID-19 restrictions (37). The argument for vaccinating children is strong for children at high risk of hospitalisation or becoming severely unwell from a SARS-CoV-2 infection, including children with neuro-disabilities, Down's syndrome, immunodeficiencies, malignancies, some cardiac, respiratory and renal diseases, obesity and poorly controlled diabetes (38), as well as those living with an immunosuppressed person or other high-risk household members (36). ...
... Furthermore, children have been affected by disruptions to day care, school and extracurricular activities, as well as the economic and mental health impacts of COVID-19 restrictions (37). The argument for vaccinating children is strong for children at high risk of hospitalisation or becoming severely unwell from a SARS-CoV-2 infection, including children with neuro-disabilities, Down's syndrome, immunodeficiencies, malignancies, some cardiac, respiratory and renal diseases, obesity and poorly controlled diabetes (38), as well as those living with an immunosuppressed person or other high-risk household members (36). Given the variants to date, the argument for vaccinating healthy children has been more nuanced, particularly when balanced with the more pressing need to vaccinate adults in low-and middle-income countries globally. ...
... Given the variants to date, the argument for vaccinating healthy children has been more nuanced, particularly when balanced with the more pressing need to vaccinate adults in low-and middle-income countries globally. The factors for and against vaccinating children have been described in more detail elsewhere (36). ...
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BACKGROUND Media narratives can shape public opinion and action. Media can influence perceptions, and action regarding COVID-19 vaccines. COVID-19 has occurred at a time where ‘infodemics’ are present, and the COVID-19 response has suffered from this infodemic. OBJECTIVE To investigate how paediatric COVID-19 vaccine narratives have unfolded in the media of four countries USA, Australia, Canada and the UK. METHODS The Narrative Policy Framework (NPF) was used to guide the analyses of the major print and online news agencies’ media regarding COVID-19 vaccines for the 5 to 11 year old age group, in four English speaking countries. Data were sought using systematic searching on Factiva of four key phases of the paediatric vaccine approval and roll-out. RESULTS 400 articles (287 for USA, 40 for Australia, 60 for Canada, and 13 for the United Kingdom) fit our search criteria and were included. Using the NPF, the following were identified in articles: hero, villain, victim, plot. The USA was the earliest to vaccinate children, and other countries’ media often lauded the USA for this. All four of USA, Australia, UK, and Canada used war imagery in reporting COVID-19 vaccines for children. The advent of the Omicron variant demonstrated that populations were fatigued by COVID-19 and the media reporting increasingly blamed those who were not vaccinated. CONCLUSIONS Analysis of the hero, villain, victim, and plot of 400 media articles about COVID-19 vaccination in children shows that the media coverage of this pandemic relies on interpersonal narrative stories. Public health emergencies require clear, compelling and above all, accurate communication. The stories told in this pandemic are compelling because they contain the classic elements of a narrative, however they can be reductive and inaccurate.
... It is important to highlight that, in addition to the individual long-term health consequences, the decision to vaccinate pediatric groups involves a thorough evaluation of factors such as population-level factors. From this standpoint, it is not possible to mitigate and control pandemics without the immunization of children and adolescents, since this measure also helps to mitigate community transmission, avoid restrictive measures, and support the return of pre-pandemic activities [203,204]. Besides the safety issues mentioned, there are many criteria that must be analyzed when evaluating vaccination in children. ...
... However, in the actual scenario, we still need more studies to confirm the long-term safety and efficacy of these vaccines in this population. measures, and support the return of pre-pandemic activities [203,204]. Besides the safety issues mentioned, there are many criteria that must be analyzed when evaluating vaccination in children. ...
... Overview about infantile vaccination for COVID-19. Adapted from Zimmerman et al.[203]. Created with BioRender.com ...
Article
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The COVID-19 pandemic has led the world to undertake the largest vaccination campaign in human history. In record time, unprecedented scientific and governmental efforts have resulted in the acquisition of immunizers utilizing different technologies (nucleotide acids, viral vectors, inactivated and protein-based vaccines). Currently, 33 vaccines have already been approved by regulatory agencies in different countries, and more than 10 billion doses have been administered worldwide. Despite the undeniable impact of vaccination on the control of the pandemic, the recurrent emergence of new variants of interest has raised new challenges. The recent viral mutations precede new outbreaks that rapidly spread at global proportions. In addition, reducing protective efficacy rates have been observed among the main authorized vaccines. Besides these issues, several other crucial issues for the appropriate combatting of the pandemic remain uncertain or under investigation. Particularly noteworthy issues include the use of vaccine-boosting strategies to increase protection; concerns related to the long-term safety of vaccines, child immunization reliability and uncommon adverse events; the persistence of the virus in society; and the transition from a pandemic to an endemic state. In this review, we describe the updated scenario regarding SARS-CoV-2 variants and COVID-19 vaccines. In addition, we outline current discussions covering COVID-19 vaccine safety and efficacy, and the future pandemic perspectives.
... Vaccinating children and adolescents against SARS-CoV2 protect from severe disease. Nevertheless, we should keep in mind that the emergence of new variants may decrease the efficacy of the actual vaccines against infection [5]. ...
... In fact, despite the existing evidence on safety and effectiveness of COVID-19 vaccines for adolescents and children, many caregivers are still hesitant toward COVID-19 vaccination for their children [5]. Several factors have been associated with hesitancy and/or refusal of pediatric COVID-19 vaccine, including the perception of a low risk of SARS-CoV-2 infection and complications in children as well as the scarcity of studies in children [7]. ...
Article
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Background COVID-19 had devastating effects on children’s and adolescents’ life, including neuropsychological impairment, discontinuation of social life and education. Since June 2021, antiCOVID19 vaccination has become available to adolescents in Italy up to 12 years and since December 2021 to children aged more than 5 years. The pediatric population represents a challenging target for vaccination. Aim of the study is to perform a survey among adolescents to explore factors associated with COVID 19 immunization and their perceptions about COVID-19 vaccines. Methods Italian students aged 10–17 years were invited to participate in an anonymous online survey regarding their immunization against COVID-19 and their opinion on the immunization practice through a web link to the questionnaire. The study period was March-June 2022. Statistical analysis was performed with SPSS v 21. Results In the study period, 895 students entered the survey. A total of 87.3% of respondents were immunized against SARS-CoV2. The most important predictors of being immunized against SARS-CoV2 were having both parents immunized ( p < 0, 001) and being aged over 12 years. In the unvaccinated group, the decision was mostly influenced by the family (65.8%). Regardless the immunization status, respondents were willing to receive information about COVID 19 vaccination mostly by their family doctor (51.8%) and at school (28.9%). Conclusions Parents’ decisions and attitudes strongly affected the immunization status of adolescents. Students’ willing to receive COVID 19 vaccine information by family doctors and at school, underline the potential role of paediatricians and school educators in contributing to an increased vaccine coverage among the paediatric age.
... The European Medicines Agency approved the Pfizer BioNTech COVID-19 vaccine for use in children aged 12 -15 years on May 28th, 2021, and for those aged 5-11 years on November 25th, 2021. Achieving suppression of the virus in the community is therefore contingent on the safe and efficient delivery of vaccines to those under 18 years of age; a group that constitutes one quarter of the world's population [1,2]. Additionally, the vaccination of children is recommended to ensure that schools and childcare facilities remain safely open and to minimise delays in accessing paediatric health services noted during the pandemic [2,3]. ...
... Achieving suppression of the virus in the community is therefore contingent on the safe and efficient delivery of vaccines to those under 18 years of age; a group that constitutes one quarter of the world's population [1,2]. Additionally, the vaccination of children is recommended to ensure that schools and childcare facilities remain safely open and to minimise delays in accessing paediatric health services noted during the pandemic [2,3]. Indeed, there is evidence that the closure of schools and associated activities had detrimental effects on children including educational disruption and reduced access to healthcare and nutritional supports [4]. ...
Article
As COVID-19 vaccination for children becomes commonplace in Ireland, it is important to understand parent’s willingness to vaccinate their children and factors associated with hesitancy and resistance. Amongst a nationally representative sample of parents from Ireland, surveyed in March/April 2021, 52.1% had, or were intending to have their child vaccinated; 30.1% reported they might vaccine their child; and 17.8% reported they would not vaccinate their child. Compared to vaccine-accepting parents, hesitant parents were more likely to be younger, less educated, poorer, to not know somebody who was sick from COVID-19, to believe the COVID-19 vaccines were unsafe, and to hold negative beliefs about scientists and healthcare professionals. Vaccine-resistant parents were more likely to be younger, living alone, to distrust scientists, and to believe the COVID-19 vaccines were unsafe. Public health messaging should target younger, lower income parents with clear information about the safety of COVID-19 vaccines for children.
... Review studies have indicated that although the risk of severe acute COVID-19 in healthy children infected with SARS-CoV-2 is considerably lower than that in adults [23,24], protecting children from the long-term consequences of COVID-19 infection and quarantine and school closures during the COVID-19 pandemic is essential [25]. The BNT162b2 vaccine (Pfizer-BioNTech) [26] and the mRNA-1273 vaccine (Moderna) [27] have been observed to be effective at reducing the risk of COVID-19 in children aged 12-17 years and have been authorized for emergency use [28][29][30][31]. ...
... The BNT162b2 vaccine (Pfizer-BioNTech) [26] and the mRNA-1273 vaccine (Moderna) [27] have been observed to be effective at reducing the risk of COVID-19 in children aged 12-17 years and have been authorized for emergency use [28][29][30][31]. Studies examining the effectiveness and safety of COVID-19 vaccines in children aged < 12 years are ongoing [25]. ...
Article
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The second wave of the Study of Taiwanese Caregivers of Children with Attention-Deficit/Hyperactivity Disorder (ADHD) in the COVID-19 Pandemic was conducted at the time of a severe COVID-19 outbreak. The aims of this study were to compare the level of the intentions of caregivers of children with ADHD to vaccinate their children between the first and second waves of study, as well as to examine the COVID-19 pandemic and non-COVID-19 pandemic factors related to caregivers’ intentions. In total, 252 caregivers of children with ADHD completed the structured questionnaires, including the Drivers of COVID-19 Vaccination Acceptance Scale; the Risk Perception of the COVID-19 Scale; caregivers’ Difficulties in Asking Their Children to Adopt Self-Protective Behavior Scale; the Brief Symptom Rating Scale; the Parental Bonding Instrument; the Swanson, Nolan, and Pelham version IV Scale; and the questionnaires for the intentions to vaccinate their children and child’s medication use for treating ADHD. The results demonstrated that 82.5% of caregivers reported their willingness to vaccinate their children definitely or under doctors’ recommendation; the level of intentions to vaccinate significantly increased compared with that of caregivers in the first wave of the study. Caregivers’ drivers of COVID-19 vaccination uptake, namely, values, impact, and autonomy but not knowledge; being male caregivers; being caregivers of girls; and the older age of the children were positively associated with caregiverscaregivers’ intentions. The specific intervention programs for enhancing caregivers’ intentions should be specified according to the sex and age of caregivers and of the children with ADHD. The Drivers of COVID-19 Vaccination Uptake should be also the target of intervention for enhancing caregivers’ intentions through strengthening caregivers’ acceptance of the COVID-19 vaccines’ values, positive impact and autonomy to vaccinate their children.
... However, the possibility of critical illnesses, such as multisystemic inflammatory syndrome in children (MIS-C) (9), cannot be ruled out in this population, especially in those with underlying disease (10). Moreover, if left unchecked, this population has the potential to become a transit reservoir for SARS-CoV-2, leading to widespread community epidemics (11)(12)(13). Furthermore, vaccination helps promote regular back-to-school education (14), which not only prevents online instructions from becoming a barrier to education for poor students, but also removes the worry of working parents (5). ...
... Besides, recent data (43) indicates that inactivated vaccination may cause pathophysiological changes in vaccine recipients similar to those in infected individuals, suggesting that careful consideration is needed when vaccinating children, even with inactivated vaccines that appear to be safer, especially for children with underlying disease. What's more, given that MIS-C may be an immune disease associated with SARS-CoV-2 infection, we cannot exclude the possibility that this complication is instead induced after COVID-19 vaccination (11). Relevant studies are urgently needed to elucidate the mechanism underlying this rare but severe disease (44). ...
Article
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Background As the epidemic progresses, universal vaccination against COVID-19 has been the trend, but there are still some doubts about the efficacy and safety of COVID-19 vaccines in adolescents, children, and even infants. Purpose To evaluate the safety, immunogenicity, and efficacy of COVID-19 vaccines in the population aged 0–17 years. Method A comprehensive search for relevant randomized controlled trials (RCTs) was conducted in PubMed, Embase, and the Cochrane Library from inception to November 9, 2021. All data were pooled by RevMan 5.3 statistical software, with risk ratio (RR) and its 95% confidence interval as the effect measure. This study protocol was registered on PROSPERO (CRD42021290205). Results There was a total of six randomized controlled trials included in this systematic review and meta-analysis, enrolling participants in the age range of 3–17 years, and containing three types of COVID-19 vaccines. Compared with mRNA vaccines and adenovirus vector vaccines, inactivated vaccines have a more satisfactory safety profile, both after initial (RR 1.40, 95% CI 1.04–1.90, P = 0.03) and booster (RR 1.84, 95% CI 1.20–2.81, P = 0.005) vaccination. The risk of adverse reactions was significantly increased after the first and second doses, but there was no significant difference between the first two doses (RR 1.00, 95%CI 0.99–1.02, P = 0.60). Nevertheless, the two-dose regimen is obviously superior to the single-dose schedule for immunogenicity and efficacy. After booster vaccination, both neutralizing antibodies (RR 144.80, 95%CI 44.97–466.24, P < 0.00001) and RBD-binding antibodies (RR 101.50, 95%CI 6.44–1,600.76, P = 0.001) reach optimal levels, but the cellular immune response seemed not to be further enhanced. In addition, compared with younger children, older children and adolescents were at significantly increased risk of adverse reactions after vaccination, with either mRNA or inactivated vaccines, accompanied by a stronger immune response. Conclusion The available evidence suggests that the safety, immunogenicity and efficacy of COVID-19 vaccines are acceptable in people aged 3–17 years. However, there is an urgent need for additional multicenter, large-sample studies, especially in younger children under 3 years of age and even in infants, with long-term follow-up data. Systematic Review Registration https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021290205 , identifier: CRD42021290205.
... A modo de ejemplo, el Reino Unido no ha aprobado el uso de vacunas en menores de 12 años, mientras que Estados Unidos aprobó la vacuna Pfizer-BioNTech para mayores de 5 años. La vacunación de adolescentes es efectiva en reducir COVID-19 grave en ese grupo, pero el costo beneficio para NNA y su efecto en el control de brotes o sobre el total de casos comunitarios es aún tema de debate entre expertos, pero aparentemente es muy bajo[55][56][57][58][59][60][61] . Sin embargo, contrario a estos datos incipientes, el 01 de noviembre 2021 Chile implementó un pasaporte sanitario como prueba de vacunación para menores de edad62 . ...
... Siendo una medida muy controversial, es llamativa la ausencia de un debate con una participación amplia de la sociedad, y no exclusivamente epidemiológico/ infectológico. Este abandono de la discusión constructiva ha ocurrido también en otros países55,56,[63][64][65] .Un ejemplo tangible sobre las medidas tomadas que incluyen a NNA, pero sin evaluar sus consecuencias, fue el reporte inicial de miocarditis en adolescentes (y hombres jóvenes) asociada a vacunas mRNA[66][67][68][69] . Hubo reticencia de entes reguladores, sociedades académicas y publicaciones científicas, que prefirieron caer en el descrédito asociándolo con movimientos antivacunas y libertarios70,71 . ...
Article
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El impacto de la pandemia COVID-19 ha sido invisibilizado en niños, niñas y adolescentes, ya que muchos de los efectos negativos han sido producto de las medidas de contención y mitigación, y sólo serán cuantificables a mediano y largo plazo. Aunque la respuesta mundial ha sido exitosa en disminuir la letalidad de la enfermedad, el efecto nocivo en poblaciones vulnerables, como niños, niñas y adolescentes es de alto impacto, catalogado como catastrófico por organismos internacionales. La pandemia ha afectado profundamente la salud física y mental de este grupo etario, y sus efectos negativos silenciosos se extienden a diferentes ámbitos como la escolaridad, economía familiar, trabajo infantil y seguridad alimentaria. El tercer año de la pandemia es una oportunidad para incorporar el bienestar multidimensional de los niños, niñas y adolescentes como piedra angular de la respuesta de la sociedad a una crisis global, sea esta de salud, económica o política.
... Sin embargo, aunque se ha demostrado, especialmente en la primera parte de la pandemia, que los niños se infectan sobre todo en el hogar más que en la escuela (30)(31)(32), también pueden infectarse y propagar la infección a su entorno. El papel del niño en la transmisión de la infección se ha subestimado claramente y además ha cambiado con la circulación de la variante ómicron (2-J o u r n a l P r e -p r o o f Journal Pre-proof 4,28,30,32). ...
... Sin embargo, aunque se ha demostrado, especialmente en la primera parte de la pandemia, que los niños se infectan sobre todo en el hogar más que en la escuela (30)(31)(32), también pueden infectarse y propagar la infección a su entorno. El papel del niño en la transmisión de la infección se ha subestimado claramente y además ha cambiado con la circulación de la variante ómicron (2-J o u r n a l P r e -p r o o f Journal Pre-proof 4,28,30,32). Las vacunas actuales son excelentes para prevenir la enfermedad grave y sus consecuencias, pero son menos efectivas frente a la infección asintomática y leve, por lo que este beneficio es menor mientras no se disponga de vacunas de segunda generación que eviten la infección. ...
... Since MIS-C in children is a life-threatening event, vaccination strategies could be considered as preventive tools. The role of COVID-19 vaccine in prevention of severe infection among children, particularly in at high-risk children (77, 78), is reported and among healthy children the chances of MIS-C are more prevalent in the absence of vaccination (79)(80)(81)(82). In patients with a history of MIS-C, an International consensus on vaccination against SARS-CoV-2 is hampered by a lack of evidence both on safety and efficacy (83). ...
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Background A severe multisystem inflammatory syndrome in children (MIS-C) related to SARS-CoV-2 has been described after infection. A limited number of reports have analyzed the long-term complications related to pro-inflammatory status in MIS-C. We evaluated multiorgan impairment at the 6-month follow-up in MIS-C. Methods We enrolled 33 pediatric patients consecutively hospitalized for MIS-C and monitored for almost 6 months. The inter-relationship of patient's features and disease severity at admission with long term complications was studied by multivariate analysis. Results Endo-metabolic derangement, cardiac injury, respiratory, renal and gastrointestinal manifestations and neurological involvement are part of the initial presentation. The most abnormalities appear to resolve within the first few weeks, without significant long term dysfunction at the 6-months follow-up, except for endocrine (non-thyroidal illness syndrome in 12.1%, insulin resistance in 21.2%) and neurological system (27.3% cognitive or psychological, behavioral, adaptive difficulties). Endocrine and heart involvement at admission represent a significant factor on the long term sequelae; however no association between severity score and long-term outcome was noted. Conclusions The severity of initial clinical presentation may be associated to organ domain, however it is not related to long term sequelae. The prevalent organ restoration supports a predominant indirect immune-mediated injury triggered by a systemic inflammatory response; however a direct damage due to the viral entry could be not excluded. Eventhought our preliminary results seem to suggest that MIS-C is not a long-term risk condition for children health, a longer follow-up is mandatory to confirm this hypothesis.
... Although the same efficacy has been demonstrated in children in the short time follow-up of initial trials run by drug companies (5), a rare but real complication in young males -acute myocarditis -have been documented by several independent reports (6). This side effect, along with the observation that most children developed a mild or asymptomatic disease, led some authors or countries to question the need of vaccinating children, as a less clear benefit-risk ratio can be demonstrated in children compared with adults (7). To make the scenario even more complicated, a huge number of children have been infected during Omicron wave and authors have claimed that previous infection would confer enough immunity to protect against severe disease in case of reinfections, therefore further questioning the utility of COVID-19 vaccines in children. ...
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Background Duration of humoral and cellular memory in children previously infected SARS-CoV-2 or vaccinated and subsequent risk of reinfection is still not fully elucidated. Methods Systematic review of studies retrieved from medical databases and article reference lists. Results From 2420 identified articles, 24 met the inclusion criteria. Children infected during the pre-omicron era developed long lasting (at least 10-12 months) humoral and cellular immunity against pre-Omicron SARS-CoV-2 variants, but have reduced in vitro cross-reactivity against Omicron. Conversely, although vaccination has a limited efficacy in preventing new infection with pre-Omicron and Omicron variants, in vitro studies suggested that vaccine-induced immunity provides better in vitro cross-neutralization against pre-Omicron and Omicron variants. Preprints published after the period of inclusion of our review suggested that overall risk of infection after Omicron infection is reduced, but children developed weak neutralizing responses in about half cases. Conclusions Available evidence, although limited, suggested a long-lasting but unperfect protection of previous infections or vaccination against pre-Omicron and Omicron variants. Based on our findings, it might be reasonable to offer families of children infected before Omicron a booster vaccination. A similar indication should be proposed also for those infected with Omicron, specifically for more fragile children at higher risk of COVID-19-related complications, based on better cross-variant neutralisation induced by vaccination. Systematic review registration PROSPERO, identifier ID 353189.
... Although COVID-19 is predominantly a mild disease in children, during the pandemic, a proportion of children ended up in intensive care units (ICUs). One of the arguments for vaccinating children against COVID-19 is to protect them from severe courses that require intensive care [1]. ...
Article
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Background: The proportion of intensive care unit (ICU) admissions in children that have and have not been directly caused by SARS-CoV-2 remains unclear. The aim of the study is to analyse a cohort of children admitted to the ICU with SARS-CoV-2 and determine whether the infection was the primary cause of their hospitalisation, a significant contributor, a suspected accomplice, or an incidental finding. Methods: This was a retrospective observational study of all the children admitted to the ICU with SARS-CoV-2 from March 2020 to February 2022 from the South Moravia region. The aim of the study was to assess whether the hospitalisation was likely to be directly caused by the virus (i.e., patients with acute COVID-19; the COVID group), whether the virus was a significant contributor to the hospitalisation (i.e., patients with multisystem inflammatory syndrome in children due to COVID-19; the MIS-C group), whether it may have contributed to the worsening of their underlying disease (the WORSENING group), or whether it was an incidental finding very likely unrelated to hospitalisation where SARS-CoV-2 positivity merely placed patients in the COVID-19 unit (the ISOLATION group). The groups were compared using a series of secondary outcomes. Results: The study population represented 150 paediatric ICU cases (age 8.6; IQR 3.5–13.3 years), with 66.7% being male. The COVID group represented 32.7% of cases (49/150); MIS-C, 30% (45/150); WORSENING, 14.7% (22/150); and ISOLATION, 22.7% (34/150). The median length of hospitalisation was found for the MIS-C group (11 days; 9 days in the ICU), the COVID group (6 days; five days in the ICU), WORSENING group (4.5 days; 4.5 days in the ICU) and the ISOLATION group (5.5 days; 3.5 days in the ICU), where the difference was significant (p < 0.001). Asymptomatic and mild cases were most common in the WORSENING (36.4% and 63.6%) and ISOLATION (52.9% and 44.1%) groups. Severe and critical cases were only present in the COVID (6.1% and 12.2%) and MIS-C (4.4% and 11.1%) groups; the severity difference was significant (p < 0.001). The groups did not differ significantly in the proportion of complete recovery and short- and long-term sequelae (p = 0.09). Conclusions: Patients with acute COVID-19 accounted for one-third of all ICU admissions, patients with MIS-C accounted for approximately another third, patients with worsening underlying disease accounted for 15%, and patients with incidental findings of SARS-CoV-2 positivity accounted for one-fifth of ICU admissions. A more significant disease was seen with acute COVID-19 and MIS-C.
... Similar debates about children and vaccines have ensued during the COVID-19 pandemic (i.e., should children even be vaccinated?) [9,69]. This debate is ongoing, but what is important is that children globally, and especially in LMIC, be proactively considered for equitable and optimized health outcomes. ...
Article
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Purpose of Review The COVID-19 pandemic, since 2020, has affected health care services and access globally. Although the entire impact of COVID-19 pandemic on existing global public health is yet to be fully seen, the impact of COVID-19 pandemic on global childhood immunization programs is of particular importance. Recent Findings Disruptions to service delivery due to lockdowns, challenges in vaccination programs, vaccine misinformation and hesitancy, and political and social economic inequalities all posed a threat to existing childhood immunization programs. These potential threats were especially critical in LMIC where childhood immunization programs tend to experience suboptimal implementation. Summary This review provides an overview of childhood immunizations and discusses past pandemics particularly in LMIC, factors contributing to disparities in childhood immunizations, and reviews potential lessons to be learned from past pandemics. Vaccine hesitancy, social determinants of health, and best practices to help lessen the pandemic’s influence are also further elaborated. To address current challenges that hindered the progress made in prevention of childhood illnesses through vaccination campaigns and increased vaccine availability, lessons learned through best practices explored from past pandemics must be examined to mitigate impact of COVID-19 on childhood immunization and in turn conserve health and improve economic well-being of children especially in LMIC.
... The most effective way to safely obtain immunity is currently vaccination [11]. Vaccinating all children could be one of the most important public health measures for preventing children or adolescents from being infected with SARS-CoV-2 [12,13]. During the continuous health crisis, parental vaccine hesitancy/delay has been a serious obstacle to vaccination for the youth population [14]. ...
Article
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The vaccination of all children may be one of the most important public health measures for preventing a wider spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in the community. Therefore, the purpose of this study was to investigate the attitude, intention, decision making, and psychological well-being among the caregivers of children who received SARS-CoV-2 vaccination in Taiwan. The caregivers of children (98 preschool children, 191 school-age children, and 154 adolescents) who received COVID-19 vaccination were invited to fill in the following questionnaires: Adopting Self-Protective Behavior Scale, Drivers of COVID-19 Vaccination Acceptance Scale, Impact of Event Scale, Chinese Health Questionnaire, and Parental Bonding Instrument. Compared to the caregivers of adolescents, the caregivers of preschool children exhibited more protective behaviors toward the COVID-19 pandemic. The caregivers of preschool children also displayed a higher emotional impact than those of adolescents and took a greater interest in the family’s opinion about vaccination. Finally, we found that COVID-19 ideological invasion and protective parenting style were significantly related to the prevalence of mental illness among caregivers. The results of this study can be used as an important reference for vaccination health care and policy formulation for adolescents with regard to COVID-19.
... As SARS-CoV-2 becomes endemic, the capacity of young children to develop potent antibody responses to this virus could provide an important contribution to herd immunity. Prevention of transmission has been proposed as an important argument in favor of COVID-19 vaccination in children [30]. Studies have suggested an impact of age on the antibody response to COVID-19 vaccination in SARS-CoV-2-naïve children, with either higher or lower responses detetected in younger as compared with older children, depending on the vaccine [31][32][33]. ...
Article
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Background The basis of the less severe clinical presentation of coronavirus disease 2019 (COVID-19) in children as compared with adults remains incompletely understood. Studies have suggested that a more potent boosting of immunity to endemic common cold coronaviruses (HCoVs) may protect children. Methods To test this hypothesis, we conducted a detailed analysis of antibodies induced by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in children aged 2 months to 14 years. Results Younger children had higher titers of antibodies to SARS-CoV-2 receptor binding domain (RBD), S1 but not S2 domain, and total spike (S) protein, higher avidity RBD immunoglobulin G, and higher titers of neutralizing and complement-activating antibodies as compared with older children. In contrast, older children had higher titers of antibodies to HCoVs, which correlated with antibodies to the SARS-CoV-2 S2 domain but not with neutralizing or complement-activating antibodies. Conclusions These results reveal a unique capacity of young children to develop effector antibody responses to SARS-CoV-2 infection independently of their immunity to HCoVs.
... On the basis of previous studies and relevant background information, we constructed an online structured questionnaire. 14,15 The contents of the questionnaire are as follows: (1) general population sociology information including age, gender, place of residence, education level, occupation and number of minor children; (2) background information on vaccination including history of vaccine allergy, previous degree of vaccine allergy, number of doses of COVID-19 vaccine accepted; (3) In order to understand the willingness of medical workers to vaccinate their children, they were asked: "Would you like to vaccinate children over the age of 3 with a COVID-19 vaccine booster?" "Very willing," "willing," "unwilling," or "extremely unwilling." Almost all questions are closed, and checkboxes are provided for answers; (4) medical staffs' opinion on child vaccination by a question: 'Do you think your child needs a booster vaccination against COVID-19?' (Three response options: yes, no, don't know); (5) medical staffs' viewpoint on child vaccination by a question: 'What are your thoughts the effectiveness of COVID-19 vaccine boosters for children?' (Three items answered this question, as measured using a five-point Likert scale 1 = strongly disagree, 5=strongly agree, the lowest score is 3 points, the highest score is 15 points, the median is 12 points (≥12 scores are considered high, <12 scores was considered low.) ...
Article
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The study aimed to determine the willingness of medical staff to have their children vaccinated with a COVID-19 booster in Taizhou, China. From March 21 to April 19, 2022, an online questionnaire survey was conducted to assess the willingness of medical staff to vaccinate their children with a booster dose of the COVID-19 vaccine. Of the 1,252 medical staff in a tertiary grade hospital in Taizhou who were invited to answer the structured questionnaire, 514 (41.1%) samples had valid information for further data analysis. Four hundred thirty-seven medical staff (85.0%) were willing to have their children receive vaccine boosters. After adjustments for confounding factors, the opinion (‘Do you think your child needs a booster vaccination against COVID-19?’) (yes vs. no, OR = 6.91, 95% CI: 3.29–14.54), the viewpoint (‘What are your thoughts the effectiveness of COVID-19 vaccine boosters for children?’ (≥12 vs. <12, OR = 13.81, 95% CI: 4.03-), and the attitude (‘Your attitude to whether your child is boosting the Covid-19 vaccine?’) (yes vs. no, OR = 4.66, 95% CI: 2.30–9.44) were significantly associated with their willingness to have their children receive a COVID-19 vaccine booster. A moderate percentage of the respondents expressed willingness to have their children receive booster vaccines. The findings implied that factors affecting medical staffs’ willingness to vaccinate their children with a COVID-19 vaccine booster included viewpoint, opinion, and attitudes.
... 5 Therefore, decrease in virus transmission has been observed in children who area vaccinated and thus will help in reducing severe cases in adults and will also tend to reduce the risk of developing certain new variants of virus. 6 There are quite a few studies which have observed that the vaccinated individuals who become infected again are on the side fewer side to transmit the virus due to reduced viral load and the duration of virus shedding and as a result, transmission from vaccinated individual to household contacts is significantly lower. [7][8][9] The factors that are to be taken into account is that efficacy and safety of the vaccine among the given population. ...
Article
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Introduction: The recent pandemic outbreak Covid-19 has led to substantial illness and ultimate mortality across the globe and childrenare highly are in the verge of being in a critical role as vectors in the transmission of SARS-CoV-2 in the community. There are quitea few studies which have observed that the vaccinated individuals who become infected again are on the side fewer side to transmit thevirus due to reduced viral load and the duration of virus shedding and as a result, transmission from vaccinated individual to householdcontacts is significantly lower. This systemic review was thus undertaken with the objective of analysing the literature that wereavailable on the safety, immunogenicity, efficacy and if any adverse effects of covid vaccination in children.Material and Methods: We conducted both a systematic review. This review was solely based on the predefined protocol and it wasconducted in concordance with PRISMA guidelines.Conclusion: The available data reports similar efficacy and safety in children as of adults. Therefore, more clinical trials are needed tobe conducted and published for evaluation of safety and if any long-term effects of Covid vaccines.
... Therefore, in this context, COVID-19 vaccination represents an important tool to protect not only frail pediatric patients but also children without comorbidities from severe disease, hospitalization, or death due to SARS-CoV-2 infection [7]. Additional reasons for vaccinating children include reducing community transmission and avoiding quarantine, school closures and other restrictions on social activities, resulting in psychological and physical benefits for the pediatric population [8,9]. ...
Article
Purpose The present study assessed the prevalence of audio-vestibular symptoms following SARS-COV-2 infection or COVID-19 vaccination among children, comparing the two groups. A further aim was to evaluate whether children with pre-existing unilateral hearing loss were more prone to adverse events. Materials and methods This retrospective study included children aged 5–11 years with normal hearing or a proven history of unilateral hearing loss who contracted SARS-CoV-2 or received two doses of COVID-19 vaccine. Tinnitus, hyperacusis, aural fullness, otalgia, otorrhea, new-onset hearing loss, vertigo and dizziness were investigated as possible complications of SARS-CoV-2 infection or the COVID-19 vaccine. Results This study included 272 children (143 boys, 129 girls), with a mean age of 7.8 ± 2.3 years. Among these, 120 were affected by pre-existing unilateral hearing loss. The most common audio-vestibular symptoms reported by children following SARS-CoV-2 infection and COVID-19 vaccination were aural fullness (33/132, 25 %) and dizziness (5/140, 3.6 %), respectively. All symptoms following COVID-19 vaccination resolved within 24 h. Compared to children who received the COVID-19 vaccine, those infected with SARS-CoV-2 had a higher prevalence of tinnitus (p = 0.009), hyperacusis (p = 0.003), aural fullness (p < 0.001), otalgia (p < 0.001), otorrhea (p < 0.001), and vertigo (p = 0.006). Two girls also experienced new-onset unilateral sensorineural hearing loss following SARS-CoV-2 infection. Children with a known history of unilateral hearing loss did not have a higher prevalence of audio-vestibular symptoms than children with normal hearing. Conclusions Our results suggest that the COVID-19 vaccine is safe and can be recommended for children with unilateral hearing loss without fear of possible audio-vestibular sequelae.
... Moreover, the uneven distribution of vaccines in various countries and regions has become an obstacle in delaying the vaccination of children [129][130][131][132]. It is reassuring that this issue is being effectively alleviated through the development of vaccines that are gradually maturing around the world, and it cannot be an obstacle from prioritizing vaccinating children [133][134][135][136][137]. Consequently, to accelerate the process of fully vaccinating all human beings against COVID-19, more clinical data related to vaccines for children are needed to dispel the concerns of parents regarding vaccine safety. ...
Article
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The coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has inflicted immense damage to countries, economies and societies worldwide. Authorized COVID-19 vaccines based on different platforms have been widely inoculated in adults, showing up to 100% immunogenicity with significant efficacy in preventing SARS-CoV-2 infections and the occurrence of severe COVID-19. It has also greatly slowed the evolution of SARS-CoV-2 variants, as shown in clinical trials and real-world evidence. However, the total dosage of COVID-19 vaccines for children is much smaller than that for adults due to limitations from parental concern of vaccine safety, presenting a potential obstacle in ending the COVID-19 pandemic. SARS-CoV-2 not only increases the risk of severe multisystem inflammatory syndrome (MIS-C) in children, but also negatively affects children's psychology and academics, indirectly hindering the maintenance and progress of normal social order. Therefore, this article examines the clinical manifestations of children infected with SARS-CoV-2, the status of vaccination against COVID-19 in children, vaccination-related adverse events, and the unique immune mechanisms of children. In particular, the necessity and challenges of vaccinating children against SARS-CoV-2 were highlighted from the perspectives of society and family. In summary, parental hesitancy is unnecessary as adverse events after COVID-19 vaccination have been proven to be infrequent, comprise of mild symptoms, and have a good prognosis.
... Using the unclear flow of information, individuals had to choose whether or not to get vaccinated and parents had to choose whether or not to vaccinate their children. This additional decision was further complicated by the fact that the cost-benefit balance of vaccination in children was highly controversial for COVID-19 [24]. Even if parents seemed to accept the vaccine (e.g., 72.6% acceptability of a free vaccine against COVID among parents in a sample of Chinese factory employees in September 2020; [25]), this did not necessarily result in their having intentions to vaccinate their children (e.g., the likelihood of child COVID-19 vaccination was as follows in March 2021 among US parents: very likely (28%), somewhat likely (18%), somewhat unlikely (9%), very unlikely (33%), and unsure (12%) [26]). ...
Article
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The COVID-19 pandemic illustrated that intolerance of uncertainty (IU) can hinder problem-solving and lead to avoidance of ambiguous situations. Furthermore, people tend to lack confidence in decisions made in ambiguous contexts. We wanted to investigate the impact of IU on intentions to get vaccinated, to vaccinate one’s children, and to recommend the vaccine in situations with varying degrees of perceived uncertainty. We first conducted a pretest to select six scenarios with different levels of perceived uncertainty. In the core study, 485 participants answered for each of the six scenarios whether they would get vaccinated, vaccinate their children (or imagine doing so, for individuals without children), and whether they would recommend the vaccine. They also completed the IUS-12 (Intolerance of Uncertainty scale) and the VAX (Vaccination Attitudes Examination). Results showed that perceived uncertainty did not influence our measures, but the IUS-12 and VAX predicted the difference in score between the most and least uncertain scenarios. An indirect effect of the IUS-12 on decision confidence through the VAX was found, but with no direct effect. We conclude that, even if future studies should refine these results, Public Policies should be more focused on factors such as IU and attitudes toward vaccination.
... In July 2021, the European Medicines Agency (EMA) authorized the Moderna vaccine for those aged 12-17 years, while vaccination of kids aged 5-11 years is still under-investigation [210]. Both vaccines have been applied, in children over the age of 12, in American, European, African and Asian countries [211][212][213][214][215][216][217][218][219][220][221][222]. While only Pfizer has been implemented for those aged 5-11 years, in Italy, the United States, Israel, United Kingdom, Germany, Ireland, Poland, France, Spain and Denmark. ...
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Background COVID-19, the coronavirus disease that emerged in December 2019, caused drastic damage worldwide. At the beginning of the pandemic, available data suggested that the infection occurs more frequently in adults than in infants. In this review, we aim to provide an overview of SARS-CoV-2 infection in children before and after B.1.617.2 Delta and B.1.1.529 Omicron variants emergence in terms of prevalence, transmission dynamics, clinical manifestations, complications and risk factors. Methods Our method is based on the literature search on PubMed, Science Direct and Google Scholar. From January 2020 to July 2022, a total of 229 references, relevant for the purpose of this review, were considered. Results The incidence of SARS-CoV-2 infection in infants was underestimated. Up to the first half of May, most of the infected children presented asymptomatic or mild manifestations. The prevalence of COVID-19 varied from country to another: the highest was reported in the United States (22.5%). COVID-19 can progress and become more severe, especially with the presence of underlying health conditions. It can also progress into Kawasaki or Multisystem Inflammatory Syndrome (MIS) manifestations, as a consequence of exacerbating immune response. With the emergence of the B.1.617.2 Delta and B.1.1.529 Omicron variants, it seems that these variants affect a large proportion of the younger population with the appearance of clinical manifestations similar to those presented by adults with important hospitalization rates. Conclusion The pediatric population constitutes a vulnerable group that requires particular attention, especially with the emergence of more virulent variants. The increase of symptomatic SARS-CoV-2 infection and hospitalization rate among children highlights the need to extend vaccination to the pediatric population.
... Vaccination against SARS-CoV-2 infection has been debatable for adolescents aged 12-15 years and even more controversial for children under 12 years of age [6]. Despite the large number of cases among children and adolescents in some countries, COVID-19 generally poses a minor risk to this age group, with less than 2% of symptomatic cases requiring hospitalization [7][8][9]. ...
Article
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The parents’ attitude toward vaccinating children and adolescents against coronavirus disease 2019 (COVID-19) remains inconsistent and needs further elucidation. The high rates of COVID-19 vaccine hesitancy in the Middle East and North Africa (MENA) region require intensive research to understand the determinants of this phenomenon. This study aimed to validate a version of the Parent Attitudes about Childhood Vaccines (PACV) tool in Arabic, the most widely spoken language in the MENA. The study objectives included the investigation of Arab-speaking parents’ views regarding COVID-19 vaccination of their children. Parents living in Egypt with at least one child aged 5–18 years were eligible to participate in the study that was conducted through an online survey with 15 PACV items. The PACV tool was translated into Arabic using forward and backward translation. To assess the psychometric properties of the Arabic version of PACV, Pearson’s correlation coefficient and exploratory and confirmatory factor analysis (EFA and CFA) were performed. A total of 223 parents participated in the study: 59.82% aged 30–39 years, 69.20% were females, 46.19% were university-educated, and 40.63% had one child. The overall Cronbach’s alpha for the Arabic version of PACV was 0.799. The EFA of the 15 items showed that three domains were most conceptually equivalent. All items had a positive significant correlation with the mean score of each subscale except for item 4 (r = 0.016, p = 0.811). Regression analyses results indicated that education, previous COVID-19 infection, vaccine status of parents, and PACV score were significantly associated with the intention of the parents to vaccinate their children against COVID-19. The CFA results showed that most of the factor loadings were statistically significant (p < 0.010) except for items 4 and 7. However, the root mean square error of approximation (RMSEA = 0.080) and the standardized root mean squared residual (SRMR = 0.080) indicated that the model had a reasonable fit, and the three factors were good in reproducing each correlation. Our study results indicated the validity and reliability of the PACV instrument in Arabic language. Consequently, the PACV can be used to assess COVID-19 vaccine hesitancy in a majority of MENA countries for better delineation of this highly prevalent phenomenon in the region.
... Policies to vaccinate children or to provide multiple booster doses require careful consideration of current evidence and benefit-risk analysis. 7,8 Beyond health and cost implications, governments should also consider any consequences on public support for vaccination programmes, including issues of vaccination fatigue or scepticism. ...
... Studies have revealed that people who have been infected can significantly benefit from vaccination. It provides them a robust, long-lasting immunity boost [35]. Nearly half of the respondents think that children who are not immunized could have their social, emotional, and intellectual abilities hampered. ...
Article
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Global health authorities have emphasized the vital role of healthcare professionals (HCPs) as a reliable source of vaccination information for patients in primary care. However, HCPs are concerned whether COVID-19 vaccinations can be used off-label. Hence, the current study was conducted to assess their perspectives towards off-label COVID-19 immunization in children. The study tool, consisting of 40 items, was utilized to evaluate HCPs’ knowledge and attitudes towards the off-label use of the COVID-19 vaccine in children under 12 years of age. To assess the unfavorable attitudes regarding vaccinations, the Vaccination Attitudes Examination Scale was employed. Overall, 477 completed questionnaires were incorporated in the present study, with a response rate of 88.9%. The mean age of the respondents was 38.6 ± 7.5 years; among whom the majority were physicians, n = 209 (43.8%), and pharmacists, n = 112 (23.4%). Approximately 78% of the respondents had a general awareness of off-label vaccination. Around 80% knew the adverse drug reactions associated with the use of COVID-19 vaccines. Females showed more mistrust about vaccine benefits, n = 55 (16.9%), compared to males, n = 21 (13.8%), and concerns about commercial profits of vaccines, n = 59 (18.1%), compared to males, n = 19 (12.5%). By profession, physicians showed statistically significantly lower mistrust, n = 18 (8.6%), and higher concerns about unpredicted effects of vaccines, n = 41 (19.6%). A major portion of the respondents, n = 327 (68.5%), did not consider that HCPs should prescribe/administer off-label COVID-19 vaccination in children. The current findings demonstrated that respondents had an appropriate level of understanding about COVID-19 immunization in children. They showed higher levels of rejection for off-label use of the COVID-19 vaccination.
... 27 But the case for mass vaccination of healthy under 5s seems less compelling, 15 particularly in developed countries where risk of mortality from covid-19 in this age group is so low. 28 However, the balance of benefits and risks may change as new variants emerge. Global surveillance of covid-19 and long term effects of vaccination in different child populations is therefore essential. ...
... Research indicates that this is due to the emergence of highly infectious variants of the virus [25]. A safe and effective vaccine is the best way to contain the COVID-19 pandemic, which has caused over 4 million deaths to date [24]. ...
Article
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Studies have shown that during the pandemic period, children under 5 years of age accounted for 1.8% of COVID-19 cases. After covid complications are now a major concern and represent a new disease entity known as PIMS and MIS-C. Many studies have been conducted on the pathomechanism of the virus and the clinical manifestations it causes in adults, including neurological complications. Symptoms are mainly associated with central and peripheral neurological disorders, ranging from mild (headache, fever, cough, pharyngitis, rhinitis and anosmia) to severe (stroke or Guillain-Barré syndrome). Dyspnoea or respiratory failure is seen in approximately 11.7% of young patients. Although SARS-CoV-2 mainly occupies the respiratory system, about 10% report gastrointestinal symptoms. CT abnormalities of the chest of children are less frequent and milder than in adults, and include opacities of frosted glass and patchy shadows. In many cases, elevated CK-MB levels have also been noted, indicating possible myocardial damage. Children and adolescents contribute to an increasing proportion of all Covid-19 cases. It can be due to the emergence of highly infectious variants of the virus. Many drugs have been tried in children both antiviral, antimalarial, corticosteroids and intravenous immunoglobulin or selective cytokine brokers. The only effective method of prophylaxis is two doses of BNT162b2 vaccine given 21 days apart.
... This might lead to a different role of children in the spread of disease and younger children may maintain circulation of the virus by serving as a reservoir. 26 The decision, whether to vaccinate younger children, is however complex and warrants consideration of several factors as summarized by Zimmerman et al. 27 One of the limitations of our study is that the description and registration of symptoms are done through telephone consultations between medical personnel and parents rather than direct clinical contact and this may cause some inaccuracy. In addition, daily TC from health care professionals were made to gather information and give advice. ...
Article
Introduction: Children are less likely to acquire SARS-CoV-2 infections than adults and when infected, usually have milder disease. True infection and complication rates are, however, difficult to ascertain. In Iceland, a strict test, trace and isolate policy was maintained from the start of the pandemic and offers more accurate information of the number of truly infected children in a nationwide study. Material and methods: All children with positive PCR for SARS-CoV-2 infections from February 28, 2020 to August 31, 2021 were followed up through telephone consultations for at least 14 days and their symptoms were registered. Symptom severity and duration were categorized based on age groups and the source of infection was registered. Results: A total of 1749 children were infected with SARS-CoV-2 in 3 waves of infections. All waves had similar disease severity whereas the incidence was 5-fold higher in the third wave (3.5 vs. 0.73/1000 children/month). No children had severe symptoms, 81 (4.6%) had moderate symptoms, 1287 (73.9%) had mild and 374 (21.5%) were asymptomatic. Symptoms from upper (n = 839, 48%) and lower respiratory tract (n = 744, 43%) were most common. Median duration of symptoms was 5 days and adolescents had a higher risk of prolonged duration [OR:1.84 (1.39-2.43)]. Nineteen (1.1%) children needed medical attention, but no child was hospitalized. The source of infection was a household member in 65% of cases. Discussion: During the first 3 waves of the pandemic, SARS-CoV-2 infections in Icelandic children were mild and none were hospitalized. The most common symptoms were respiratory symptoms followed by fever, headache and tiredness. This study helps shed light on true complication rates of children with confirmed SARS-CoV-2 infection.
... In our study, the incidence of COVID-19 after vaccination was 200 of 11 042 cases, and it was significantly lower after the second dose compared to the first dose (p< 0.001) (Table 3). More studies are needed to assess the consequences of vaccines on COIVD-19 and maybe last some years.[35][36][37][38][39][40][41] 5 | LIMITATIONSLimitations in our study include the lack of an accurate registration system in medical centers, reliance on telephone reports, and lack of full cooperation by some parents to provide accurate information about their child's illness. ...
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Background: To determine the safety and efficacy profile of teenager COVID-19 vaccination. Methods: In this retrospective cohort study, contact numbers of parents of teenagers under 18 years of age referred to a teenager vaccination centers in Tehran-Iran to receive the corona vaccine were collected and following information were obtained via the phones:demographic information, type of vaccine and number of doses received, and additional information,like complications, required treatments. Results: 11,042 subjects aged 10-18 years, mean age 14.55 ± 1.83 year s , including 5374 boys and 5768 girls were investigated. 88.1% received the Sinopharm and 11.9% the Soberana vaccine. General side effects, including fatigue, fever and chills, injection site painand dizziness, etc. happened in 2978 cases, 7421 children presented with at least one general or organ-specific side effect following vaccination, including potentially critical side effects,such as vascular injuries, respiratory complication, etc.0.1% of the subject needed hospital admission. The breakthrough infection happened in 200 individuals. Conclusion: Our study shows that Sinopharm and Soberana (PastoCoVac) COVID-19 vaccine are generally safe with no serious side effects in fewer than 18 years old. COVID19 infection and reinfection can occur after vaccination, but the incidence is actually tolerable and significantly lower than in the unvaccinated group. This article is protected by copyright. All rights reserved.
... Vaccination has been one of the cornerstones of the public health response to However, there has been some debate over the need to vaccinate children due to the relatively lower severity of infection in this age group. 1 While vaccination has been available in the UK for those aged 16 years and above since December 2020, vaccination has subsequently been extended to younger age groups (Box 1). Box 1. Timeline of recommendations for COVID-19 vaccination in children and adolescents in England. 2 December 2020. ...
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Objectives To investigate UK parents’ vaccination intention at a time when COVID-19 vaccination was available to some children. Study design Data reported are from the second wave of a prospective cohort study. Methods Online survey of 270 UK parents (conducted 4-15 October 2021). At this time, vaccination was available to 16- and 17-year-olds and had become available to 12- to 15- year-olds two weeks prior. We asked participants whose child had not yet been vaccinated how likely they were to vaccinate their child for COVID-19. Linear regression analyses were used to investigate factors associated with intention. Parents were also asked for their main reasons behind vaccination intention. Open-ended responses were analysed using content analysis. Results Parental vaccination intention was mixed (likely: 39.3%, 95% CI 32.8%, 45.7%; uncertain: 33.9%, 27.7%, 40.2%; unlikely: 26.8%, 20.9%, 32.6%). Intention was associated with: parental COVID-19 vaccination status; greater perceived necessity and social norms regarding COVID-19 vaccination; greater COVID-19 threat appraisal; and lower vaccine safety and novelty concerns. In those who intended to vaccinate their child, the main reasons for doing so were to protect the child and others. In those who did not intend to vaccinate their child, the main reason was safety concerns. Conclusions Parent COVID-19 vaccination and psychological factors explained a large percentage of the variance in vaccination intention for one’s child. How fluctuating infection rates, more children being vaccinated, and the UK’s reliance on vaccination as a strategy to live with COVID-19 may impact parents’ intention to vaccinate their child requires further study.
... One of the key characteristics of the SARS-CoV-2 pandemic has been the striking age-dependent nature of disease severity, with older (and clinically vulnerable) individuals suffering a far higher burden of hospital admissions and deaths [9][10][11][12]. Many countries initially closed schools as a response to this pandemic [13][14][15][16], but the role played by school-aged children and the strength of transmission within the school environment remains deeply contested with different conclusions being drawn from a range of modelling and data-driven analyses [17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33]. This dichotomy of views on the role of schools may be attributed to two conflicting factors. ...
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Background Children and young persons are known to have a high number of close interactions, often within the school environment, which can facilitate rapid spread of infection; yet for SARS-CoV-2, it is the elderly and vulnerable that suffer the greatest health burden. Vaccination, initially targeting the elderly and vulnerable before later expanding to the entire adult population, has been transformative in the control of SARS-CoV-2 in England. However, early concerns over adverse events and the lower risk associated with infection in younger individuals means that the expansion of the vaccine programme to those under 18 years of age needs to be rigorously and quantitatively assessed. Methods Here, using a bespoke mathematical model matched to case and hospital data for England, we consider the potential impact of vaccinating 12–17 and 5–11-year-olds. This analysis is reported from an early model (generated in June 2021) that formed part of the evidence base for the decisions in England, and a later model (from November 2021) that benefits from a richer understanding of vaccine efficacy, greater knowledge of the Delta variant wave and uses data on the rate of vaccine administration. For both models, we consider the population wide impact of childhood vaccination as well as the specific impact on the age groups targeted for vaccination. Results Projections from June suggested that an expansion of the vaccine programme to those 12–17 years old could generate substantial reductions in infection, hospital admission and deaths in the entire population, depending on population behaviour following the relaxation of control measures. The benefits within the 12–17-year-old cohort were less marked, saving between 660 and 1100 (95% PI (prediction interval) 280–2300) hospital admissions and between 22 and 38 (95% PI 9–91) deaths depending on assumed population behaviour. For the more recent model, the benefits within this age group are reduced, saving on average 630 (95% PI 300–1300) hospital admissions and 11 (95% PI 5–28) deaths for 80% vaccine uptake, while the benefits to the wider population represent a reduction of 8–10% in hospital admissions and deaths. The vaccination of 5–11-year-olds is projected to have a far smaller impact, in part due to the later roll-out of vaccines to this age group. Conclusions Vaccination of 12–170-year-olds and 5–11-year-olds is projected to generate a reduction in infection, hospital admission and deaths for both the age groups involved and the population in general. For any decision involving childhood vaccination, these benefits needs to be balanced against potential adverse events from the vaccine, the operational constraints on delivery and the potential for diverting resources from other public health campaigns.
... While the risk of severe Covid-19 in healthy children is substantially lower than among adults, vaccinating children may reduce community transmission, avoid potentially life-threatening presentations such as multisystemic in ammatory syndrome (MIS-C), and prevent long-term consequences of SARS-CoV-2 infection. 9 Although numerous countries are vaccinating children, few have authorized vaccines for children under ve, and some have restricted vaccines for children older than 12 years. 10 Evidence of the e cacy or effectiveness of Covid-19 vaccines in children is limited, primarily related to mRNA vaccines, and only one study was conducted during the omicron outbreak. ...
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The outbreak of the B.1.1.529 lineage of SARS-CoV-2 (omicron) has caused an unprecedented number of Covid-19 cases, including pediatric hospital admissions. Policymakers urgently need evidence of vaccine effectiveness in children to balance the costs and benefits of vaccination campaigns, but the evidence is sparse or non-existing. Leveraging a population-based cohort of 490,694 children aged 3–5 years, we estimated the effectiveness of administering a two-dose schedule, 28 days apart, of CoronaVac using inverse probability-weighted survival regression models to estimate hazard ratios of complete immunization over non-vaccination, accounting for time-varying vaccination exposure and relevant confounders. The study was conducted between December 6, 2021, and February 26, 2022, during the omicron outbreak in Chile. The estimated vaccine effectiveness was 38.2% (95%CI, 36.5–39.9) against Covid-19, 64.6% (95%CI, 49.6–75.2) against hospitalization, and 69.0% (95%CI, 18.6–88.2) to prevent intensive care unit admission. The effectiveness was modest; however, protection against severe disease remained high.
... Vaccination against SARS-CoV-2 has been an important tool to protect the population, including children 12-15 years old, from severe illness and long-term complications However, vaccination in children under 12 years old has been controversial because, although there are multiple benefits, there are also potential risks [81]. Recently, a clinical study evaluated two mRNA vaccines against SARS-CoV-2 in children younger than 12 years of age showing the safety, immunogenicity, and efficacy of vaccination in this pediatric population [82]. ...
Article
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As a result of the COVID-19 pandemic, various joint efforts have been made to support the creation of vaccines. Different projects have been under development, of which some are in the clinical evaluation stage and others in are in phase III with positive results. The aim of this paper was to describe the current situation of the development and production of vaccines available to the population to facilitate future research and continue developing and proposing ideas for the benefit of the population. So, we carried out a systematic review using databases such as PubMed, ScienceDirect, SciELO, and MEDLINE, including keywords such as “vaccines,” “COVID-19,” and “SARS-CoV-2”. We reviewed the development and production of the anti-COVID vaccine and its different platforms, the background leading to the massive development of these substances, and the most basic immune aspects for a better understanding of their physiological activity and the immune response in those who receive the vaccine. We also analyzed immunization effects in populations with any medical or physiological conditions (such as immunosuppression, people with comorbidities, and pregnancy), as well as the response to immunization with heterologous vaccines and the hybrid immunity (the combination of natural immunity to SARS-CoV-2 with immunity generated by the vaccine). Likewise, we address the current situation in Mexico and its role in managing the vaccination process against SARS-CoV-2 at the national and international levels. There are still many clinical and molecular aspects to be described, such as the duration of active immunity and the development of immunological memory, to mention some of the most important ones. However, due to the short time since the global vaccination roll-out and that it has been progressive (not counting children and people with medical conditions), it is premature to say whether a second vaccination schedule will be necessary for the near future. Thus, it is essential to continue with health measures.
... The rather low risk of acute COVID-19 disease in children along with concerns raised over the impairments from vaccination and disease signify that the balance of vaccination risks and benefits in this age group is more complex. Moreover, the appearance of novel variants of concern demands constant re-evaluation of the risks and benefits [226]. Initial short estimations suggest that although the long-term outcome of acute pediatric myocarditis is relatively good, there is a risk of chronic left ventricular dysfunction (CLVF); complete regression and CVLVD and late deaths owing to cardiac failure occur in 73% and 27% of cases, respectively [227]. ...
Article
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The persistence of the coronavirus disease 2019 (COVID-19) pandemic has triggered research into limiting transmission, morbidity and mortality, thus warranting a comprehensive approach to guide balanced healthcare policies with respect to people’s physical and mental health. The mainstay priority during COVID-19 is to achieve widespread immunity, which could be established through natural contact or vaccination. Deep knowledge of the immune response combined with recent specific data indicates the potential inferiority of induced immunity against infection. Moreover, the prevention of transmission has been founded on general non-pharmacological measures of protection, albeit debate exists considering their efficacy and, among other issues, their socio-psychological burden. The second line of defense is engaged after infection and is supported by a plethora of studied agents, such as antibiotics, steroids and non-steroid anti-inflammatory drugs, antiviral medications and other biological agents that have been proposed, though variability in terms of benefits and adverse events has not allowed distinct solutions, albeit certain treatments might have a role in prevention and/or treatment of the disease. This narrative review summarizes the existing literature on the advantages and weaknesses of current COVID-19 management measures, thus underlining the necessity of acting based on the classical principle of “ofeleein i mi vlaptin”, that is, to help or not to harm.
... One of the key characteristics of the SARS-CoV-2 pandemic has been the striking age-dependent nature of disease severity, with older (and clinically vulnerable) individuals su↵ering a far higher burden of hospital admissions and deaths [7][8][9][10]. Many countries initially closed schools as a response to this pandemic [11][12][13][14], but the role played by school-aged children and the strength of transmission within the school environment remain deeply contested with di↵erent conclusions being drawn from a range of modelling and data-driven analyses [15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31]. This dichotomy of views on the role of schools may be attributed to two conflicting factors. ...
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Background Children and young persons are known to have a high number of close interactions, often within the school environment, which can facilitate rapid spread of infection; yet for SARS-CoV-2 it is the elderly and vulnerable that suffer the greatest health burden. Vaccination, initially targeting the elderly and vulnerable but later expanded to the entire adult population, has been transformative in the control of SARS-CoV-2 in England. However, early concerns over adverse events and the lower risk associated with infection in younger individuals means that the expansion of the vaccine programme to those under 18 year of age needs to be rigorously and quantitatively assessed. Methods Here, using a bespoke mathematical model matched to case and hospital data for England, we consider the potential impact of vaccinating 12-17 and 5-11 year olds. This analysis is reported from an early model (generated in June 2021) that formed part of the evidence base for the decisions in England, and a later model (from November 2021) that benefits from a richer understanding of vaccine efficacy, greater knowledge of the Delta variant wave and uses data on the rate of vaccine administration. For both models we consider the population wide impact of childhood vaccination as well as the specific impact on the age-group targeted for vaccination. Results Projections from June suggested that an expansion of the vaccine programme to those 12-17 years old could generate substantial reductions in infection, hospital admission and deaths in the entire population, depending on population behaviour following the relaxation of control measures. The benefits within the 12-17 year old cohort were less marked, saving between 656 and 1077 (95% prediction interval 281-2260) hospital admissions and between 22 and 38 (95% PI 9-91) deaths depending on assumed population behaviour. For the more recent model, the benefits within this age group are reduced, saving on average 631 (95% PI 304-1286) hospital admissions and 11 (95% PI 5-28) deaths for 80% vaccine uptake, while the benefits to the wider population represent a reduction of 8-10% in hospital admissions and deaths. The vaccination of 5-11 year olds is projected to have a far smaller impact, in part due to the later roll-out of vaccines to this age-group. Conclusions Vaccination of 12-17 year olds and 5-11 year olds is projected to generate a reduction in infection, hospital admission and deaths for both the age-groups involved and the population in general. For any decision involving childhood vaccination, these benefits needs to be balanced against potential adverse events from the vaccine, the operational constraints on delivery and the potential for diverting resources from other public health campaigns.
Article
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Background: The mass vaccination of children against coronavirus 2019 disease (COVID-19) has been frequently debated. The risk–benefit assessment of COVID-19 vaccination versus infection in children has also been debated. Aim: This systematic review looked for answers to the question “was the vaccination of our children valuable and successful?”. Methods: The search strategy of different articles in the literature was based on medical subject headings. Screening and selection were based on inclusion/exclusion criteria. Results and Discussion: The search results revealed that the majority of the reported adverse events after COVID-19 vaccination in pediatrics were mild to moderate, with few being severe. Injection site discomfort, fever, headache, cough, lethargy, and muscular aches and pains were the most prevalent side effects. Few clinical studies recorded significant side effects, although the majority of these adverse events had nothing to do with vaccination. In terms of efficacy, COVID-19 disease protection was achieved in 90–95% of cases for mRNA vaccines, in 50–80% of cases for inactivated vaccines, and in 58–92% of cases for adenoviral-based vaccines in children and adolescents. Conclusions: Based on available data, COVID-19 immunizations appear to be safe for children and adolescents. Furthermore, multiple studies have proven that different types of vaccines can provide excellent protection against COVID-19 in pediatric populations. The efficacy of vaccines against new SARS-CoV-2 variants and the reduction in vaccine-related long-term adverse events are crucial for risk–benefit and cost-effectiveness assessments; therefore, additional safety studies are required to confirm the long-term safety and effectiveness of vaccinations in children.
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Introduction: The balance of risks and benefits of COVID-19 vaccination in children is more complex than in adults with limited paediatric data resulting in no global consensus on whether all healthy children should be vaccinated. We sought to assess the safety, efficacy, and effectiveness of childhood vaccination against SARS-CoV-2, as well as better understanding perceptions of vaccination in parents and vaccine experts. Methods: We performed a literature review for COVID-19 vaccine safety, efficacy, effectiveness, and perceptions. We searched international safety databases for safety data and developed an electronic survey to elicit country-specific COVID-19 immunisation data, including vaccine regulations, policies, rates, and public attitudes solicited from vaccine experts. Results: Nine studies were included in the final safety analysis. Local reactions were frequently reported across all studies and vaccine types. Adverse events reported to surveillance systems tended to be non-serious, and commonly included injection site reactions and dizziness. Twenty-three studies reported immunogenicity, efficacy, and effectiveness data. There were nine randomised control trials of six different vaccine types, which showed seroconversion of neutralising antibodies in vaccinated children ranging from 88% to 100%. The vaccine efficacy for Pfizer and Moderna vaccines ranged from 88% to 100%. There were 118 survey responses representing 55 different countries. Reported vaccination rates ranged from <1% to 98%. Most respondents described "mixed opinions" regarding paediatric vaccination policies in their country. By region, a more positive public attitude towards vaccination correlated with higher vaccination rates. Discussion: In this mixed-methods review, we have found evidence that vaccination against COVID-19 in children is safe, efficacious, and effective. Overall, the combined evidence from both the literature review and survey highlights the need for further data on both the safety and effectiveness of COVID-19 vaccinations in children.
Article
Background: Media narratives can shape public opinion and action, influencing people's perceptions and action regarding uptake of paediatric COVID-19 vaccines. COVID-19 has occurred at a time where 'infodemics', 'misinformation', and 'disinformation' are present, and as a result the COVID-19 response has suffered. Objective: To investigate how narratives about paediatric COVID-19 vaccines have unfolded in the media of four English-speaking countries; USA, Australia, Canada and the UK. Methods: The Narrative Policy Framework (NPF) was used to guide the comparative analyses of the major print and online news agencies' media regarding COVID-19 vaccines for the 5 to 11 year old age group. Data were sought using systematic searching on Factiva of four key phases of the paediatric vaccine approval and roll-out. Results: 400 articles (287 for USA, 40 for Australia, 60 for Canada, and 13 for the United Kingdom) fit the search criteria and were included. Using the NPF, the following were identified in each of the articles: hero, villain, victim, plot. The USA was the earliest to vaccinate children, and other countries' media often lauded the USA for this. Australian and Canadian media narratives about 5-11 year old vaccines were commonly about protecting vulnerable people in society, whereas the USA and the UK narratives focused more on the vaccine helping children get back to school. All four countries focused on the 5-11 year old vaccine as being key to 'ending' the pandemic. Australian and Canadian narratives frequently compared vaccine roll-outs across states/provinces, and bemoaned local progress in vaccine delivery in comparison to other countries globally. Canadian and USA narratives highlighted the 'infodemic' about COVID-19 and disinformation regarding child vaccines as impeding uptake. All four of USA, Australia, UK, and Canada used war imagery in reporting about COVID-19 vaccines for children. The advent of the Omicron variant demonstrated that populations were fatigued by COVID-19 and the media reporting increasingly blamed those who were not vaccinated. The UK media narrative was unique in that it frequently described vaccinating children as a distraction from adult COVID-19 vaccination efforts. The USA and Canada had narratives expressing anger about potential vaccine passports for children. In Australia, general practitioners (GPs) were enveloped in the language of heroism. And lastly, the Canadian narrative was unique in expressing the desire to forgo adult COVID-19 vaccine 'boosters', as well as paediatric COVID-19 vaccines in order to ensure other adults globally could receive their initial vaccines. Conclusions: Public health emergencies require clear, compelling and above all, accurate communication. The stories told in this pandemic are compelling because they contain the classic elements of a narrative, however they can be reductive and inaccurate. Clinicaltrial:
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The outbreak of the B.1.1.529 lineage of SARS-CoV-2 (Omicron) has caused an unprecedented number of COVID-19 cases, including pediatric hospital admissions. Policymakers urgently need evidence of vaccine effectiveness in children to balance the costs and benefits of vaccination campaigns, but to date, the evidence is sparse. Leveraging a population-based cohort in Chile of 490,694 children aged 3-5 years, we estimated the effectiveness of administering a two-dose schedule, 28 days apart, of Sinovac’s inactivated SARS-CoV-2 vaccine (CoronaVac). We used inverse probability-weighted survival regression models to estimate hazard ratios of symptomatic COVID-19, hospitalization, and admission to an intensive care unit (ICU) for children with complete immunization over non-vaccination, accounting for time-varying vaccination exposure and relevant confounders. The study was conducted between December 6, 2021, and February 26, 2022, during the Omicron outbreak in Chile. The estimated vaccine effectiveness was 38.2% (95% confidence intervals, CI, 36.5–39.9) against symptomatic COVID-19, 64.6% (95%CI, 49.6–75.2) against hospitalization, and 69.0% (95%CI, 18.6–88.2) against ICU admission. The effectiveness against symptomatic COVID-19 was modest. However, protection against severe disease was high. These results support vaccination of children 3-5 years to prevent severe illness and associated complications and highlight the importance of maintaining layered protections against SARS-CoV-2 infection. CoronaVac protects young children from severe COVID-19 during a SARS-CoV-2 Omicron surge, supporting the effectiveness and importance of vaccinating this pediatric population.
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The optimal SARS-CoV-2 vaccine strategy for patients with a history of MIS-C is unclear. We performed an international survey (32 countries) and found substantial variations in vaccine policies. Respondents did not report relapses of MIS-C or other severe inflammatory side effects after SARS-CoV-2 vaccination in 273 patients with a history of MIS-C.
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An Era of SARS‐COVID‐19 out broke with a high contagious percentage around the globe has been the subject of multi‐agency research aimed at generating vaccines for active immunization. Scientists across the world are joining hands for the advanced tie‐ups between the medical start‐ups and the pharmaceutical industries for devices and vaccines development to hinder the progress of this outbreak. Moreover, the questions that need to be answered are how to improve the effectiveness and efficacy of vaccines with reduced side effects and the required doses of vaccines for enhanced surveillance. In this review article, we have discussed the effectiveness and efficacy of different Covid‐19 vaccines. This article is protected by copyright. All rights reserved.
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Our results showed that adolescents with kidney diseases who are receiving immunosuppression or KRT could respond to 2 doses of BNT162b2 reasonably, but their antibody level was lower than that in healthy adolescents. As these patients are at increased risk of mortality from Covid, it is important to protect them with a robust antibody response from vaccination. mRNA vaccines were found to be associated with myocarditis and pericarditis in adolescents, therefore Hong Kong and the United Kingdom, among other places, previously recommended a single dose of BNT162b2 for adolescents. Our results support that immune response to a third dose of Covid vaccine should be studied in pediatric renal patients on KRT or immunosuppression to better protect them against severe Covid.
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Background Reports have suggested an association between the development of myocarditis and the receipt of messenger RNA (mRNA) vaccines against coronavirus disease 2019 (Covid-19), but the frequency and severity of myocarditis after vaccination have not been extensively explored. Methods We searched the database of Clalit Health Services, the largest health care organization (HCO) in Israel, for diagnoses of myocarditis in patients who had received at least one dose of the BNT162b2 mRNA vaccine (Pfizer–BioNTech). The diagnosis of myocarditis was adjudicated by cardiologists using the case definition used by the Centers for Disease Control and Prevention. We abstracted the presentation, clinical course, and outcome from the patient’s electronic health record. We performed a Kaplan–Meier analysis of the incidence of myocarditis up to 42 days after the first vaccine dose. Results Among more than 2.5 million vaccinated HCO members who were 16 years of age or older, 54 cases met the criteria for myocarditis. The estimated incidence per 100,000 persons who had received at least one dose of vaccine was 2.13 cases (95% confidence interval [CI], 1.56 to 2.70). The highest incidence of myocarditis (10.69 cases per 100,000 persons; 95% CI, 6.93 to 14.46) was reported in male patients between the ages of 16 and 29 years. A total of 76% of cases of myocarditis were described as mild and 22% as intermediate; 1 case was associated with cardiogenic shock. After a median follow-up of 83 days after the onset of myocarditis, 1 patient had been readmitted to the hospital, and 1 had died of an unknown cause after discharge. Of 14 patients who had left ventricular dysfunction on echocardiography during admission, 10 still had such dysfunction at the time of hospital discharge. Of these patients, 5 underwent subsequent testing that revealed normal heart function. Conclusions Among patients in a large Israeli health care system who had received at least one dose of the BNT162b2 mRNA vaccine, the estimated incidence of myocarditis was 2.13 cases per 100,000 persons; the highest incidence was among male patients between the ages of 16 and 29 years. Most cases of myocarditis were mild or moderate in severity. (Funded by the Ivan and Francesca Berkowitz Family Living Laboratory Collaboration at Harvard Medical School and Clalit Research Institute.)
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Background Approximately 5.1 million Israelis had been fully immunized against coronavirus disease 2019 (Covid-19) after receiving two doses of the BNT162b2 messenger RNA vaccine (Pfizer–BioNTech) by May 31, 2021. After early reports of myocarditis during adverse events monitoring, the Israeli Ministry of Health initiated active surveillance. Methods We retrospectively reviewed data obtained from December 20, 2020, to May 31, 2021, regarding all cases of myocarditis and categorized the information using the Brighton Collaboration definition. We analyzed the occurrence of myocarditis by computing the risk difference for the comparison of the incidence after the first and second vaccine doses (21 days apart); by calculating the standardized incidence ratio of the observed-to-expected incidence within 21 days after the first dose and 30 days after the second dose, independent of certainty of diagnosis; and by calculating the rate ratio 30 days after the second dose as compared with unvaccinated persons. Results Among 304 persons with symptoms of myocarditis, 21 had received an alternative diagnosis. Of the remaining 283 cases, 142 occurred after receipt of the BNT162b2 vaccine; of these cases, 136 diagnoses were definitive or probable. The clinical presentation was judged to be mild in 129 recipients (95%); one fulminant case was fatal. The overall risk difference between the first and second doses was 1.76 per 100,000 persons (95% confidence interval [CI], 1.33 to 2.19), with the largest difference among male recipients between the ages of 16 and 19 years (difference, 13.73 per 100,000 persons; 95% CI, 8.11 to 19.46). As compared with the expected incidence based on historical data, the standardized incidence ratio was 5.34 (95% CI, 4.48 to 6.40) and was highest after the second dose in male recipients between the ages of 16 and 19 years (13.60; 95% CI, 9.30 to 19.20). The rate ratio 30 days after the second vaccine dose in fully vaccinated recipients, as compared with unvaccinated persons, was 2.35 (95% CI, 1.10 to 5.02); the rate ratio was again highest in male recipients between the ages of 16 and 19 years (8.96; 95% CI, 4.50 to 17.83), with a ratio of 1 in 6637. Conclusions The incidence of myocarditis, although low, increased after the receipt of the BNT162b2 vaccine, particularly after the second dose among young male recipients. The clinical presentation of myocarditis after vaccination was usually mild.
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What is already known about this topic? COVID-19 can cause severe illness in children and adolescents. What is added by this report? Weekly COVID-19-associated hospitalization rates among children and adolescents rose nearly five-fold during late June-mid-August 2021, coinciding with increased circulation of the highly transmissible SARS-CoV-2 Delta variant. The proportions of hospitalized children and adolescents with severe disease were similar before and during the period of Delta predominance. Hospitalization rates were 10 times higher among unvaccinated than among fully vaccinated adolescents. What are the implications for public health practice? Preventive measures to reduce transmission and severe outcomes in children and adolescents are critical, including vaccination, universal masking in schools, and masking by persons aged >2 years in other indoor public spaces and child care centers.
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Introduction: There is uncertainty surrounding the diagnosis, prevalence, phenotype, duration and treatment of Long COVID. This study aims to (A) describe the clinical phenotype of post-COVID symptomatology in children and young people (CYP) with laboratory-confirmed SARS-CoV-2 infection compared with test-negative controls, (B) produce an operational definition of Long COVID in CYP, and (C) establish its prevalence in CYP. Methods and analysis: A cohort study of SARS-CoV-2-positive CYP aged 11-17 years compared with age, sex and geographically matched SARS-CoV-2 test-negative CYP. CYP aged 11-17 testing positive and negative for SARS-CoV-2 infection will be identified and contacted 3, 6, 12 and 24 months after the test date. Consenting CYP will complete an online questionnaire. We initially planned to recruit 3000 test positives and 3000 test negatives but have since extended our target. Data visualisation techniques will be used to examine trajectories over time for symptoms and variables measured repeatedly, separately by original test status. Summary measures of fatigue and mental health dimensions will be generated using dimension reduction methods such as latent variables/latent class/principal component analysis methods. Cross-tabulation of collected and derived variables against test status and discriminant analysis will help operationalise preliminary definitions of Long COVID. Ethics and dissemination: Research Ethics Committee approval granted. Data will be stored in secure Public Health England servers or University College London's Data Safe Haven. Risks of harm will be minimised by providing information on where to seek support. Results will be published on a preprint server followed by journal publication, with reuse of articles under a CC BY licence. Data will be published with protection against identification when there are small frequencies involved. Trial registration number: ISRCTN34804192; Pre-results.
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OBJECTIVES. Examine age differences in SARS-CoV-2 transmission risk from primary cases and infection risk among household contacts, and symptoms among those with SARS-CoV-2 infection. METHODS. People with SARS-CoV-2 infection in Nashville, Tennessee and central and western Wisconsin and their household contacts were followed daily for 14 days to ascertain symptoms and secondary transmission events. Households were enrolled between April 2020 and April 2021. Secondary infection risks (SIR) by age of the primary case and contacts were estimated using generalized estimating equations. RESULTS. The 226 primary cases were followed by 197 (49%) secondary SARS-CoV-2 infections among 404 household contacts. Age group-specific SIR among contacts ranged from 35% to 53%, with no differences by age. SIR was lower from primary cases aged 12-17 years than from primary cases 18-49 years (risk ratio [RR] 0.42; 95% confidence interval [CI] 0.19-0.92). SIR was 56% and 45%, respectively, among primary case-contact pairs in the same versus different age group (RR 1.54; 95% CI 1.03-2.31). SIR was highest among primary case-contacts pairs aged ≥65 years (77%) and 5-11 years (70%). Among secondary SARS-CoV-2 infections, 19% were asymptomatic; there was no difference in the frequency of asymptomatic infections by age group. CONCLUSIONS. Both children and adults can transmit and are susceptible to SARS-CoV-2 infection. SIR did not vary by age, but further research is needed to understand age-related differences in probability of transmission from primary cases by age.
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Importance As a result of low numbers of pediatric cases early in the COVID-19 pandemic, pediatric household transmission of SARS-CoV-2 remains an understudied topic. Objective To determine whether there are differences in the odds of household transmission by younger children compared with older children. Design, Setting, and Participants This population-based cohort study took place between June 1 and December 31, 2020, in Ontario, Canada. Private households in which the index case individual of laboratory-confirmed SARS-CoV-2 infection was younger than 18 years were included. Individuals were excluded if they resided in apartments missing suite information, in households with multiple index cases, or in households where the age of the index case individual was missing. Exposures Age group of pediatric index cases categorized as 0 to 3, 4 to 8, 9 to 13, and 14 to 17 years. Main Outcomes and Measures Household transmission, defined as households where at least 1 secondary case occurred 1 to 14 days after the pediatric index case. Results A total of 6280 households had pediatric index cases, and 1717 households (27.3%) experienced secondary transmission. The mean (SD) age of pediatric index case individuals was 10.7 (5.1) years and 2863 (45.6%) were female individuals. Children aged 0 to 3 years had the highest odds of transmitting SARS-CoV-2 to household contacts compared with children aged 14 to 17 years (odds ratio, 1.43; 95% CI, 1.17-1.75). This association was similarly observed in sensitivity analyses defining secondary cases as 2 to 14 days or 4 to 14 days after the index case and stratified analyses by presence of symptoms, association with a school/childcare outbreak, or school/childcare reopening. Children aged 4 to 8 years and 9 to 13 years also had increased odds of transmission (aged 4-8 years: odds ratio, 1.40; 95% CI, 1.18-1.67; aged 9-13 years: odds ratio, 1.13; 95% CI, 0.97-1.32). Conclusions and Relevance This study suggests that younger children may be more likely to transmit SARS-CoV-2 infection compared with older children, and the highest odds of transmission was observed for children aged 0 to 3 years. Differential infectivity of pediatric age groups has implications for infection prevention within households, as well as schools/childcare, to minimize risk of household secondary transmission. Additional population-based studies are required to establish the risk of transmission by younger pediatric index cases.
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Background The incidence of coronavirus disease 2019 (Covid-19) among adolescents between 12 and 17 years of age was approximately 900 per 100,000 population from April 1 through June 11, 2021. The safety, immunogenicity, and efficacy of the mRNA-1273 vaccine in adolescents are unknown. Methods In this ongoing phase 2–3, placebo-controlled trial, we randomly assigned healthy adolescents (12 to 17 years of age) in a 2:1 ratio to receive two injections of the mRNA-1273 vaccine (100 μg in each) or placebo, administered 28 days apart. The primary objectives were evaluation of the safety of mRNA-1273 in adolescents and the noninferiority of the immune response in adolescents as compared with that in young adults (18 to 25 years of age) in a phase 3 trial. Secondary objectives included the efficacy of mRNA-1273 in preventing Covid-19 or asymptomatic severe acute respiratory syndrome coronavirus 2 infection. Results A total of 3732 participants were randomly assigned to receive mRNA-1273 (2489 participants) or placebo (1243 participants). In the mRNA-1273 group, the most common solicited adverse reactions after the first or second injections were injection-site pain (in 93.1% and 92.4%, respectively), headache (in 44.6% and 70.2%, respectively), and fatigue (in 47.9% and 67.8%, respectively); in the placebo group, the most common solicited adverse reactions after the first or second injections were injection-site pain (in 34.8% or 30.3%, respectively), headache (in 38.5% and 30.2%, respectively), and fatigue (in 36.6% and 28.9%, respectively). No serious adverse events related to mRNA-1273 or placebo were noted. The geometric mean titer ratio of pseudovirus neutralizing antibody titers in adolescents relative to young adults was 1.08 (95% confidence interval [CI], 0.94 to 1.24), and the absolute difference in serologic response was 0.2 percentage points (95% CI, −1.8 to 2.4), which met the noninferiority criterion. No cases of Covid-19 with an onset of 14 days after the second injection were reported in the mRNA-1273 group, and four cases occurred in the placebo group. Conclusions The mRNA-1273 vaccine had an acceptable safety profile in adolescents. The immune response was similar to that in young adults, and the vaccine was efficacious in preventing Covid-19. (Funded by Moderna and the Biomedical Advanced Research and Development Authority; Teen COVE ClinicalTrials.gov number, NCT04649151.)
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Importance The BNT162b2 (Pfizer-BioNTech) messenger RNA COVID-19 vaccine was authorized on May 10, 2021, for emergency use in children aged 12 years and older. Initial reports showed that the vaccine was well tolerated without serious adverse events; however, cases of myocarditis have been reported since approval. Objective To review results of comprehensive cardiac imaging in children with myocarditis after COVID-19 vaccine. Design, Setting, and Participants This study was a case series of children younger than 19 years hospitalized with myocarditis within 30 days of BNT162b2 messenger RNA COVID-19 vaccine. The setting was a single-center pediatric referral facility, and admissions occurred between May 1 and July 15, 2021. Main Outcomes and Measures All patients underwent cardiac evaluation including an electrocardiogram, echocardiogram, and cardiac magnetic resonance imaging. Results Fifteen patients (14 male patients [93%]; median age, 15 years [range, 12-18 years]) were hospitalized for management of myocarditis after receiving the BNT162b2 (Pfizer) vaccine. Symptoms started 1 to 6 days after receipt of the vaccine and included chest pain in 15 patients (100%), fever in 10 patients (67%), myalgia in 8 patients (53%), and headache in 6 patients (40%). Troponin levels were elevated in all patients at admission (median, 0.25 ng/mL [range, 0.08-3.15 ng/mL]) and peaked 0.1 to 2.3 days after admission. By echocardiographic examination, decreased left ventricular (LV) ejection fraction (EF) was present in 3 patients (20%), and abnormal global longitudinal or circumferential strain was present in 5 patients (33%). No patient had a pericardial effusion. Cardiac magnetic resonance imaging findings were consistent with myocarditis in 13 patients (87%) including late gadolinium enhancement in 12 patients (80%), regional hyperintensity on T2-weighted imaging in 2 patients (13%), elevated extracellular volume fraction in 3 patients (20%), and elevated LV global native T1 in 2 patients (20%). No patient required intensive care unit admission, and median hospital length of stay was 2 days (range 1-5). At follow-up 1 to 13 days after hospital discharge, 11 patients (73%) had resolution of symptoms. One patient (7%) had persistent borderline low LV systolic function on echocardiogram (EF 54%). Troponin levels remained mildly elevated in 3 patients (20%). One patient (7%) had nonsustained ventricular tachycardia on ambulatory monitor. Conclusions and Relevance In this small case series study, myocarditis was diagnosed in children after COVID-19 vaccination, most commonly in boys after the second dose. In this case series, in short-term follow-up, patients were mildly affected. The long-term risks associated with postvaccination myocarditis remain unknown. Larger studies with longer follow-up are needed to inform recommendations for COVID-19 vaccination in this population.
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Background In children, SARS-CoV-2 infection is usually asymptomatic or causes a mild illness of short duration. Persistent illness has been reported; however, its prevalence and characteristics are unclear. We aimed to determine illness duration and characteristics in symptomatic UK school-aged children tested for SARS-CoV-2 using data from the COVID Symptom Study, one of the largest UK citizen participatory epidemiological studies to date. Methods In this prospective cohort study, data from UK school-aged children (age 5–17 years) were reported by an adult proxy. Participants were voluntary, and used a mobile application (app) launched jointly by Zoe Limited and King's College London. Illness duration and symptom prevalence, duration, and burden were analysed for children testing positive for SARS-CoV-2 for whom illness duration could be determined, and were assessed overall and for younger (age 5–11 years) and older (age 12–17 years) groups. Children with longer than 1 week between symptomatic reports on the app were excluded from analysis. Data from symptomatic children testing negative for SARS-CoV-2, matched 1:1 for age, gender, and week of testing, were also assessed. Findings 258 790 children aged 5–17 years were reported by an adult proxy between March 24, 2020, and Feb 22, 2021, of whom 75 529 had valid test results for SARS-CoV-2. 1734 children (588 younger and 1146 older children) had a positive SARS-CoV-2 test result and calculable illness duration within the study timeframe (illness onset between Sept 1, 2021, and Jan 24, 2021). The most common symptoms were headache (1079 [62·2%] of 1734 children), and fatigue (954 [55·0%] of 1734 children). Median illness duration was 6 days (IQR 3–11) versus 3 days (2–7) in children testing negative, and was positively associated with age (Spearman's rank-order rs 0·19, p<0·0001). Median illness duration was longer for older children (7 days, IQR 3–12) than younger children (5 days, 2–9). 77 (4·4%) of 1734 children had illness duration of at least 28 days, more commonly in older than younger children (59 [5·1%] of 1146 older children vs 18 [3·1%] of 588 younger children; p=0·046). The commonest symptoms experienced by these children during the first 4 weeks of illness were fatigue (65 [84·4%] of 77), headache (60 [77·9%] of 77), and anosmia (60 [77·9%] of 77); however, after day 28 the symptom burden was low (median 2 symptoms, IQR 1–4) compared with the first week of illness (median 6 symptoms, 4–8). Only 25 (1·8%) of 1379 children experienced symptoms for at least 56 days. Few children (15 children, 0·9%) in the negatively tested cohort had symptoms for at least 28 days; however, these children experienced greater symptom burden throughout their illness (9 symptoms, IQR 7·7–11·0 vs 8, 6–9) and after day 28 (5 symptoms, IQR 1·5–6·5 vs 2, 1–4) than did children who tested positive for SARS-CoV-2. Interpretation Although COVID-19 in children is usually of short duration with low symptom burden, some children with COVID-19 experience prolonged illness duration. Reassuringly, symptom burden in these children did not increase with time, and most recovered by day 56. Some children who tested negative for SARS-CoV-2 also had persistent and burdensome illness. A holistic approach for all children with persistent illness during the pandemic is appropriate. Funding Zoe Limited, UK Government Department of Health and Social Care, Wellcome Trust, UK Engineering and Physical Sciences Research Council, UK Research and Innovation London Medical Imaging and Artificial Intelligence Centre for Value Based Healthcare, UK National Institute for Health Research, UK Medical Research Council, British Heart Foundation, and Alzheimer's Society.
Preprint
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SARS-CoV-2 variant B.1.617.2 (delta) is associated with higher viral loads [1] and increased transmissibility relative to other variants, as well as partial escape from polyclonal and monoclonal antibodies [2]. The emergence of the delta variant has been associated with increasing case counts and test-positivity rates, indicative of rapid community spread. Since early July 2021, SARS-CoV-2 cases in the United States have increased coincident with delta SARS-CoV-2 becoming the predominant lineage nationwide [3]. Understanding how and why the virus is spreading in settings where there is high vaccine coverage has important public health implications. It is particularly important to assess whether vaccinated individuals who become infected can transmit SARS-CoV-2 to others. In Wisconsin, a large local contract laboratory provides SARS-CoV-2 testing for multiple local health departments, providing a single standard source of data using the same assay to measure virus burdens in test-positive cases. This includes providing high-volume testing in Dane County, a county with extremely high vaccine coverage. These PCR-based tests provide semi-quantitative information about the viral load, or amount of SARS-CoV-2 RNA, in respiratory specimens. Here we use this viral load data to compare the amount of SARS-CoV-2 present in test-positive specimens from people who self-report their vaccine status and date of final immunization, during a period in which the delta variant became the predominant circulating variant in Wisconsin. We find no difference in viral loads when comparing unvaccinated individuals to those who have vaccine "breakthrough" infections. Furthermore, individuals with vaccine breakthrough infections frequently test positive with viral loads consistent with the ability to shed infectious viruses. Our results, while preliminary, suggest that if vaccinated individuals become infected with the delta variant, they may be sources of SARS-CoV-2 transmission to others.
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Objectives Highly effective vaccines against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have been developed but variants of concerns (VOCs) with mutations in the spike protein are worrisome, especially B.1.617.2 (Delta) which has rapidly spread across the world. We aim to study if vaccination alters virological and serological kinetics in breakthrough infections. Methods We conducted a multi-centre retrospective cohort study of patients in Singapore who had received a licensed mRNA vaccine and been admitted to hospital with B.1.617.2 SARS-CoV-2 infection. We compared the clinical features, virological and serological kinetics (anti-nucleocapsid, anti-spike and surrogate virus neutralization titres) between fully vaccinated and unvaccinated individuals. Results Of 218 individuals with B.1.617.2 infection, 84 had received a mRNA vaccine of which 71 were fully vaccinated, 130 were unvaccinated and 4 received a non-mRNA. Despite significantly older age in the vaccine breakthrough group, the odds of severe COVID-19 requiring oxygen supplementation was significantly lower following vaccination (adjusted odds ratio 0.07 95%CI: 0.015-0.335, p=0.001). PCR cycle threshold (Ct) values were similar between both vaccinated and unvaccinated groups at diagnosis, but viral loads decreased faster in vaccinated individuals. Early, robust boosting of anti-spike protein antibodies was observed in vaccinated patients, however, these titers were significantly lower against B.1.617.2 as compared with the wildtype vaccine strain. Conclusion The mRNA vaccines are highly effective at preventing symptomatic and severe COVID-19 associated with B.1.617.2 infection. Vaccination is associated with faster decline in viral RNA load and a robust serological response. Vaccination remains a key strategy for control of COVID-19 pandemic.
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During July 2021, 469 cases of COVID-19 associated with multiple summer events and large public gatherings in a town in Barnstable County, Massachusetts, were identified among Massachusetts residents; vaccination coverage among eligible Massachusetts residents was 69%. Approximately three quarters (346; 74%) of cases occurred in fully vaccinated persons (those who had completed a 2-dose course of mRNA vaccine [Pfizer-BioNTech or Moderna] or had received a single dose of Janssen [Johnson & Johnson] vaccine ≥14 days before exposure). Genomic sequencing of specimens from 133 patients identified the B.1.617.2 (Delta) variant of SARS-CoV-2, the virus that causes COVID-19, in 119 (89%) and the Delta AY.3 sublineage in one (1%). Overall, 274 (79%) vaccinated patients with breakthrough infection were symptomatic. Among five COVID-19 patients who were hospitalized, four were fully vaccinated; no deaths were reported. Real-time reverse transcription-polymerase chain reaction (RT-PCR) cycle threshold (Ct) values in specimens from 127 vaccinated persons with breakthrough cases were similar to those from 84 persons who were unvaccinated, not fully vaccinated, or whose vaccination status was unknown (median = 22.77 and 21.54, respectively). The Delta variant of SARS-CoV-2 is highly transmissible (1); vaccination is the most important strategy to prevent severe illness and death. On July 27, CDC recommended that all persons, including those who are fully vaccinated, should wear masks in indoor public settings in areas where COVID-19 transmission is high or substantial.* Findings from this investigation suggest that even jurisdictions without substantial or high COVID-19 transmission might consider expanding prevention strategies, including masking in indoor public settings regardless of vaccination status, given the potential risk of infection during attendance at large public gatherings that include travelers from many areas with differing levels of transmission.
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Genetic variants of SARS-CoV-2 have repeatedly altered the course of the COVID-19 pandemic, and disease in individual patients. Delta variants (B.1.617.2, AY.2, and AY.3) are now the focus of international concern because they are causing widespread COVID-19 disease globally. Vaccine breakthrough cases caused by SARS-CoV-2 variants also are of considerable public health and medical concern worldwide. As part of a comprehensive project, we sequenced the genomes of 3,913 SARS-CoV-2 from patient samples acquired March 15, 2021 through July 3, 2021 in the Houston Methodist hospital system and studied vaccine breakthrough cases. During the study period Delta variants increased to cause 58% of all COVID-19 cases and spread throughout the metropolitan Houston area. In addition, Delta variants caused a significantly higher rate of vaccine breakthrough cases (19.7% compared to 5.8% for all other variants). Importantly, only 6.5% of all COVID-19 cases occurred in fully immunized individuals, and relatively few of these patients required hospitalization. Our genomic and epidemiologic data emphasize that vaccines used in the United States are highly effective in decreasing severe COVID-19 disease, hospitalizations, and deaths.
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Background Deaths in children and young people (CYP) following SARS-CoV-2 infection are rare. Quantifying the risk of mortality is challenging because of high relative prevalence of asymptomatic and non-specific disease manifestations. Therefore, it is important to differentiate between CYP who have died of SARS-CoV-2 and those who have died of an alternative disease process but coincidentally tested positive. Methods During the pandemic, the mandatory National Child Mortality Database (NCMD) was linked to Public Health England (PHE) testing data to identify CYP (<18 years) who died with a positive SARS-CoV-2 test. A clinical review of all deaths from March 2020 to February 2021 was undertaken to differentiate between those who died of SARS-CoV-2 infection and those who died of an alternative cause but coincidentally tested positive. Then, using linkage to national hospital admission data, demographic and comorbidity details of CYP who died of SARS-CoV-2 were compared to all other deaths. Absolute risk of death was estimated where denominator data were available. Findings 3105 CYP died from all causes during the first pandemic year in England. 61 of these deaths occurred in CYP who tested positive for SARS-CoV-2. 25 CYP died of SARS-CoV-2 infection; 22 from acute infection and three from PIMS-TS. 99·995% of CYP with a positive SARS-CoV-2 test survived. The 25 CYP who died of SARS-CoV-2 equates to a mortality rate of 2/million for the 12,023,568 CYP living in England. CYP >10 years, of Asian and Black ethnic backgrounds, and with comorbidities were over-represented compared to other children. Interpretation SARS-CoV-2 is very rarely fatal in CYP, even among those with underlying comorbidities. These findings are important to guide families, clinicians and policy makers about future shielding and vaccination.
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Identifying which children and young people (CYP) are vulnerable to severe disease following SARS-CoV-2 is important to guide shielding and vaccination policy. Methods We used data for all inpatient hospital admissions in England in CYP aged 0-17 between March 1st 2015 to Feb 28th 2021, linked to paediatric intensive care unit (PICU) admission, and SARS-CoV-2 PCR testing, and deaths. We calculated odds ratios and predicted probability of PICU admission using generalized estimation equations, and compared these between COVID-19, PIMS-TS, other admissions in 2020/21, all admissions in 2019/20, and admissions due to influenza in 20219/20. Findings There were 6,338 COVID-19 hospitalisations, 259 PICU admissions and 8 deaths as well as 712 PIMS-TS hospitalisations, 312 PICU admissions and <5 deaths. Odds of PICU admission were increased amongst neonates and decreased amongst 15-17 compared with 1-4 year olds with COVID-19, increased in older CYP and females with PIMS-TS, and increased for Black compared with White ethnicity for both conditions. Odds of PICU admission with COVID-19 were increased for CYP with any comorbidity and were highest for CYP with multiple medical problems. Comorbidities associated with PICU admission among COVID-19 patients were similar to overall PICU admissions in 2019/20 and to influenza PICU admissions in 2019/20, but with higher odds. Interpreting associations with comorbidities within PIMS-TS was complex due to the multisystem nature of the disease. Interpretation CYP were at very low risk of severe disease and death from COVID-19 or PIMS-TS. Patterns of vulnerability for severe COVID-19 appear to magnify background risk factors for serious illness in CYP.
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Background The long-term sequelae of coronavirus disease 2019 (Covid-19) in children remain poorly characterised. This study aimed to assess long-term outcomes in children previously hospitalised with Covid-19 and associated risk factors. Methods This is a prospective cohort study of children (≤18 years old) admitted with confirmed Covid-19. Children admitted to the hospital between April 2, 2020 and August 26, 2020, were included. Telephone interview using the International Severe Acute Respiratory and emerging Infection Consortium (ISARIC) Covid-19 Health and Wellbeing paediatric follow-up survey. Persistent symptoms (>5 months) were further categorised by system(s) involved. Findings 518 of 853 (61%) of eligible children were available for the follow-up assessment and included in the study. Median age was 10.4 years (IQR, 3–15.2) and 270 (52.1%) were girls; median follow-up since hospital discharge was 256 (223–271) days. At the time of the follow-up interview 126 (24.3%) participants reported persistent symptoms among which fatigue (53, 10.7%), sleep disturbance (36, 6.9%,) and sensory problems (29, 5.6%) were the most common. Multiple symptoms were experienced by 44 (8.4%) participants. Risk factors for persistent symptoms were: older age “6–11 years” (odds ratio 2.74 (95% confidence interval 1.37 to 5.75) and “12–18 years” (2.68, 1.41 to 5.4); and a history of allergic diseases (1.67, 1.04 to 2.67). Interpretation A quarter of children experienced persistent symptoms months after hospitalization with acute covid-19 infection, with almost one in ten experiencing multi-system involvement. Older age and allergic diseases were associated with higher risk of persistent symptoms at follow-up.
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Long-term complications after coronavirus disease 2019 (COVID-19) are common in hospitalized patients, but the spectrum of symptoms in milder cases needs further investigation. We conducted a long-term follow-up in a prospective cohort study of 312 patients—247 home-isolated and 65 hospitalized—comprising 82% of total cases in Bergen during the first pandemic wave in Norway. At 6 months, 61% (189/312) of all patients had persistent symptoms, which were independently associated with severity of initial illness, increased convalescent antibody titers and pre-existing chronic lung disease. We found that 52% (32/61) of home-isolated young adults, aged 16–30 years, had symptoms at 6 months, including loss of taste and/or smell (28%, 17/61), fatigue (21%, 13/61), dyspnea (13%, 8/61), impaired concentration (13%, 8/61) and memory problems (11%, 7/61). Our findings that young, home-isolated adults with mild COVID-19 are at risk of long-lasting dyspnea and cognitive symptoms highlight the importance of infection control measures, such as vaccination. Analysis of a prospectively enrolled cohort of patients with SARS-CoV-2 infections in Bergen, Norway, reveals a high proportion of patients who experienced long COVID symptoms at 6 months, despite being relatively young and having only mild to moderate acute COVID-19 symptoms.
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COVID-19 is generally mild in children¹ and post-acute inflammatory conditions that are temporally associated with the virus are rare, but potentially severe. However, some children and adults experience persistent symptoms after COVID-19. ² Long COVID has not been precisely defined, but one study reported symptoms approximately 60 days after the primary diagnosis.³ Although adult long COVID is increasingly being studied, the magnitude of persistent symptoms in children remains unclear.
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Importance Multisystem inflammatory syndrome in children (MIS-C) is associated with recent or current SARS-CoV-2 infection. Information on MIS-C incidence is limited. Objective To estimate population-based MIS-C incidence per 1 000 000 person-months and to estimate MIS-C incidence per 1 000 000 SARS-CoV-2 infections in persons younger than 21 years. Design, Setting, and Participants This cohort study used enhanced surveillance data to identify persons with MIS-C during April to June 2020, in 7 jurisdictions reporting to both the Centers for Disease Control and Prevention national surveillance and to Overcoming COVID-19, a multicenter MIS-C study. Denominators for population-based estimates were derived from census estimates; denominators for incidence per 1 000 000 SARS-CoV-2 infections were estimated by applying published age- and month-specific multipliers accounting for underdetection of reported COVID-19 case counts. Jurisdictions included Connecticut, Georgia, Massachusetts, Michigan, New Jersey, New York (excluding New York City), and Pennsylvania. Data analyses were conducted from August to December 2020. Exposures Race/ethnicity, sex, and age group (ie, ≤5, 6-10, 11-15, and 16-20 years). Main Outcomes and Measures Overall and stratum-specific adjusted estimated MIS-C incidence per 1 000 000 person-months and per 1 000 000 SARS-CoV-2 infections. Results In the 7 jurisdictions examined, 248 persons with MIS-C were reported (median [interquartile range] age, 8 [4-13] years; 133 [53.6%] male; 96 persons [38.7%] were Hispanic or Latino; 75 persons [30.2%] were Black). The incidence of MIS-C per 1 000 000 person-months was 5.1 (95% CI, 4.5-5.8) persons. Compared with White persons, incidence per 1 000 000 person-months was higher among Black persons (adjusted incidence rate ratio [aIRR], 9.26 [95% CI, 6.15-13.93]), Hispanic or Latino persons (aIRR, 8.92 [95% CI, 6.00-13.26]), and Asian or Pacific Islander (aIRR, 2.94 [95% CI, 1.49-5.82]) persons. MIS-C incidence per 1 000 000 SARS-CoV-2 infections was 316 (95% CI, 278-357) persons and was higher among Black (aIRR, 5.62 [95% CI, 3.68-8.60]), Hispanic or Latino (aIRR, 4.26 [95% CI, 2.85-6.38]), and Asian or Pacific Islander persons (aIRR, 2.88 [95% CI, 1.42-5.83]) compared with White persons. For both analyses, incidence was highest among children aged 5 years or younger (4.9 [95% CI, 3.7-6.6] children per 1 000 000 person-months) and children aged 6 to 10 years (6.3 [95% CI, 4.8-8.3] children per 1 000 000 person-months). Conclusions and Relevance In this cohort study, MIS-C was a rare complication associated with SARS-CoV-2 infection. Estimates for population-based incidence and incidence among persons with infection were higher among Black, Hispanic or Latino, and Asian or Pacific Islander persons. Further study is needed to understand variability by race/ethnicity and age group.
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What is already known about this topic? Most COVID-19-associated hospitalizations occur in adults, but severe disease occurs in all age groups, including adolescents aged 12-17 years. What is added by this report? COVID-19 adolescent hospitalization rates from COVID-NET peaked at 2.1 per 100,000 in early January 2021, declined to 0.6 in mid-March, and rose to 1.3 in April. Among hospitalized adolescents, nearly one third required intensive care unit admission, and 5% required invasive mechanical ventilation; no associated deaths occurred. What are the implications for public health practice? Recent increased hospitalization rates in spring 2021 and potential for severe disease reinforce the importance of continued COVID-19 prevention measures, including vaccination and correct and consistent mask wearing among persons not fully vaccinated or when required.
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Using data from 4678 children participating in VirusWatch, a UK household cohort study, we estimated the prevalence of persistent symptoms as 1.7%, and 4.6% in children with a history of SARS-CoV-2 infection. Persistent symptoms prevalence was higher in girls, teenagers and children with long-term conditions.
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Backround Post-COVID19 complications such as pediatric inflammatory multisystem syndrome (PIMS) and Long-COVID19 move increasingly into focus, potentially causing more harm in this age group than the acute infection. To better understand the symptoms of long-COVID19 in adolescents and to distinguish infection-associated symptoms from pandemic-associated symptoms, we conducted a Long-COVID19 survey, comparing responses from seropositive and seronegative adolescents. To our knowledge, data of Long-COVID19 surveys with seronegative control groups have not been published yet. Methods Since May 2020 students grade 8-12 in fourteen secondary schools in Eastern Saxony were enrolled in the SchoolCovid19 study. Seroprevalence was assessed via serial SARS-CoV-2 antibody testing in all participants. Furthermore, during the March/April 2021 study visit all participants were asked to complete a 12 question Long-COVID19 survey regarding the occurrence and frequency of difficulties concentrating, memory loss, listlessness, headache, abdominal pain, myalgia/ arthralgia, fatigue, insomnia and mood (sadness, anger, happiness and tenseness). Findings 1560 students with a median age of 15 years participated in this study. 1365 (88%) were seronegative, 188 (12%) were seropositive. Each symptom was present in at least 35% of the students within the last seven days before the survey. However, there was no statistical difference comparing the reported symptoms between seropositive students and seronegative students. Whether the infection was known or unknown to the participant did not influence the prevalence of symptoms. Interpretation The lack of differences comparing the reported symptoms between seropositive and seronegative students suggests that Long-COVID19 might be less common than previously thought and emphasizing the impact of pandemic-associated symptoms regarding the well-being and mental health of young adolescents. Funding This study was supported by a grant by the Federal State of Saxony. M.K.W. was supported by the Else Kroener-Fresenius Center for Digital Health (EKFZ), TU Dresden, Germany.