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The future of COVID-19 vaccination rates for children

Authors:
Huynh Giao at Ho Chi Minh City Medicine and Pharmacy University
Huynh Giao
Kimberly H Nguyen at U.S. Food and Drug Administration
Kimberly H Nguyen
Nguyen Thi Ngoc Han at University Medical Center of HCMC
Nguyen Thi Ngoc Han
Tran Diep Tuan at Ho Chi Minh City Medicine and Pharmacy University
Tran Diep Tuan
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The future of COVID-19 vaccination rates for children
Giao Huynh1, Kimberly H. Nguyen2, Han Thi Ngoc Nguyen3, Tuan Diep Tran4, Pham Le An5
1Faculty of Public Health, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
2Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA
3Infection Control Department, University Medical Center Ho Chi Minh City, Ho Chi Minh City, Vietnam
4Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
5Family Medicine Training Center, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
The COVID-19 pandemic has been ongoing for over two years
since the first case was reported in the end of January 2020. Vietnam
has successfully controlled the pandemic through its vaccination
campaign, targeted messages and applications of various public
health interventions including social distancing, quarantining,
masking, and hand washing, which have made some significant
achievements in reducing hospitalizations and deaths[1].
Mass COVID-19 vaccinations became available in Vietnam in
the middle of March 2021 for individuals aged 18 and older. The
Vietnam Government has put forward various strategies to enhance
the vaccination rate, such as making vaccinations available to
the population free of charge and easily accessible in convenient
locations. The COVID-19 vaccine has been demonstrated to be
safe and effective in protecting against severe disease, hospital
admissions, and death, in addition to reducing the transmission
of new variants[1]. Millions of individuals have been safely
vaccinated with the COVID-19 vaccines. Vaccines were approved
for adolescents aged 12 years and older in October 2021 and for
children ages 5 to under 12 years in April 2022. As of August 2022,
almost all adolescents aged 12-17 years have received a series of
two doses, while 82.0% and 52.9% of children aged 5-11 years
received the first dose or are fully vaccinated respectively[2]. While
the Vietnam Government issued booster dose guidance for children
aged 12 years and older, 50.9% of this age group received a booster
dose[2]. Despite declining COVID-19 morbidity and mortality due
to increased vaccination coverage, hesitancy toward the vaccine
persists, particularly toward the booster vaccine, even though it can
protect against the new variants. Previous studies found that the main
reasons for parental vaccine hesitancy for their children were beliefs
regarding side effects of the vaccine, a desire to delay and follow up
on the safety of the vaccine, and fear of new vaccines[3,4].
Generally, children and adolescents are at lower risk of infection as
compared to adults and their signs and symptoms tend to be milder
than adults[5]. However, children have an increased risk for severe
morbidity and mortality if they have risk factors including older age,
obesity, and current morbidity conditions [type 2 diabetes, severe
asthma, heart and pulmonary diseases, seizure disorders, and other
neurologic diseases, neurodevelopmental (e.g. Down syndrome)]
and neuromuscular illness[6]. Furthermore, children infected by
SARS-CoV-2 may have experienced prolonged clinical symptoms,
known as long COVID-19[7]. Because of the low percentage of
children receiving the COVID-19 vaccine, along with the re-opening
of schools for face-to-face teaching and the relaxing of public health
measures (such as physical distancing, suspension of screening
for students in schools), it is possible that COVID-19 cases will
increase in the community, especially the new Omicron variant
and its subvariants, which are more transmissible due to its shorter
incubation period. As a result, it is more likely to cause reinfection,
particularly among the unvaccinated population, overwhelm an
already overloaded healthcare system, and cause interruptions to the
other essential services[8]. Therefore, the high risk of having another
government shut down is likely[9]. Experiences from other countries
show that decreased immunization (i.e. measles vaccines) has led
to a significant increase in the incidence and mortality of vaccine-
preventable diseases[10]. Furthermore, children may be exposed to
the virus in daycare centers or schools and may subsequently spread
the virus to their family members and community. Evidence showed
COVID-19 outbreaks were more likely to occur in secondary
Asian Pacific Journal of Tropical Medicine 2022; 15(9): 381-382
Asian Pacific Journal of Tropical Medicine
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How to cite this article: Huynh G, Nguyen KH, Nguyen HTN, Tran TD, An PL.
The future of COVID-19 vaccination rates for children. Asian Pac J Trop Med 2022;
15(9): 381-382.
Perspective
To whom correspondence may be addressed. E-mail: hgiaoytcc@ump.edu.vn
Article history: Received 25 September 2022 Revision 26 September 2022
Accepted 28 September 2022 Available online 30 September 2022
10.4103/1995-7645.356991 Impact Factor: 3.041
[Downloaded free from http://www.apjtm.org on Saturday, October 1, 2022, IP: 245.131.147.198]
382 Giao Huynh et al./ Asian Pacific Journal of Tropical Medicine 2022; 15(9): 381-382
schools and daycare centers where preventive measures such as
social distancing and masks were not practiced[11].
The Vietnamese Government has strengthened vaccination coverage
efforts for children and adolescents, including implementing many
mobile vaccination teams to allow for vaccination to occur in
convenient locations such as schools, health stations. This will also
offer more opportunities for delivery on weekdays, by collaborating
with schools and also using social media to remind parents about
upcoming vaccinations, which means translational research is
required. It is likely that SARS-CoV-2 will continue to evolve, and
it is not possible to predict how infectious or severe new variants of
the virus will be. Therefore, it is critical to achieve and maintain the
high rate of vaccination coverage across all communities in Vietnam.
Moreover, vaccination reduces the risk of shutting down schools
and education facilities, causing disruptions to educational services,
and affecting the children’s mental health. As a result, it is strongly
recommended that children and adolescents be vaccinated against
COVID-19 as soon as they are eligible (including booster doses) to
protect their health as the CDC recommendation.
Disclaimer
The author, Giao Huynh, as the Deputy Editor-in-Chief of the
Journal, contributed to this article in her personal capacity. The
views expressed are her own and do not necessarily represent the
view of the institutions she is affiliated with.
Conflict of interest statement
The authors declare that there is no conflict of interest.
Funding
The authors received no extramural funding for the study.
Authors’ contributions
The conceptualization was done by HG and PLA. The literature and
drafting of the manuscripts were conducted by HG and NTNH. The
editing and supervision were performed by NKH, TDT and PLA.
All the authors substantially contributed to drafting and revising
the manuscripts, as well as the final approval of the version to be
submitted.
References
[1] CDC. Benefits of getting a COVID-19 vaccine. 2022. [Online]. Available
from: https://www.cdc.gov/coronavirus/2019-ncov/vaccines/vaccine-
benefits.html. [Accessed on 15 September 2022].
[2] World Health Organization. COVID-19 in Viet Nam situation report 98.
2022. [Online]. Available from: https://www.who.int/vietnam/internal-
publications-detail/covid-19-in-viet-nam-situation-report-98. [Accessed
on 15 September 2022].
[3] Nguyen KH, Nguyen K, Geddes M, Allen JD, Corlin L. Trends in
adolescent COVID-19 vaccination receipt and parental intent to vaccinate
their adolescent children, United States, July to October, 2021. Ann Med
2022; 54(1): 733-742.
[4] Huynh G, Nguyen HTN, Van Tran K, Le An P, Tran TD. Determinants
of COVID-19 vaccine hesitancy among parents in Ho Chi Minh City,
Vietnam. Postgrad Med 2022; 134(3): 303-308.
[5] Ludvigsson JF. Systematic review of COVID-19 in children shows milder
cases and a better prognosis than adults. Acta Paediatr 2020; 109(6):
1088-1095.
[6] Shi Q, Wang Z, Liu J, Wang X, Zhou Q, Li Q, et al. Risk factors for poor
prognosis in children and adolescents with COVID-19: A systematic
review and meta-analysis. EClinicalMedicine 2021; 41: 101155.
[7] Lopez-Leon S, Wegman-Ostrosky T, Ayuzo Del Valle NC, Perelman
C, Sepulveda R, Rebolledo PA, et al. Long-COVID in children and
adolescents: A systematic review and meta-analyses. Sci Rep 2022; 12(1):
9950.
[8] World Health Organization. Enhancing response to Omicron SARS-
CoV-2 variant. 2021. [Online]. Available from: https://www.who.int/
publications/m/item/enhancing-readiness-for-omicron-(b.1.1.529)-
technical-brief-and-priority-actions-for-member-states. [Accessed on 15
September 2022].
[9] Huynh G, Nguyen HT, Pham AL. Recovery of child immunization
programs post COVID-19. Asian Pac J Trop Med 2021; 14: 429-430.
[10] Leong WY, Wilder-Smith AB. Measles resurgence in Europe: Migrants
and travellers are not the main drivers. J Epidemiol Glob Health 2019;
9(4): 294-299.
[11] Xu W, Li X, Dozier M, He Y, Kirolos A, Lang Z, et al. What is the
evidence for transmission of COVID-19 by children in schools? A living
systematic review. J Glob Health 2020; 10(2): 021104.
Publisher's note
The Publisher of the Journal remains neutral with regard to
jurisdictional claims in published maps and institutional affiliations.
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... Many countries have adopted home quarantine measures to prevent the spread of COVID-19 in schools [13], which has seriously affected the children's normal schooling and outdoor activities [14], and may have a negative effect on their mental health and well-being [15]. The vaccination of juveniles is an important part of developing herd immunity and allowing the opening up of societies [16,17]. Personal experience, perceived effectiveness, and concerns regarding safety and adverse effects are the most influential factors in predicting parents' decision to vaccinate their children [18]. ...
COVID-19 vaccine uptake and associated factors among teenagers and their parents in Zhejiang, China: An online cross-sectional study
Article
Full-text available
  • Apr 2023
Objective: To examine COVID-19 vaccine uptake and its determinants among teenagers and their parents in Zhejiang, China. Methods: An online cross-sectional study was conducted among parents of teenagers in Zhejiang, China from May 1 to 31, 2022. Data were interpreted via univariate and multivariate analyses using the statistical package for the social sciences (SPSS) program. Results: A total of 11115 (96.11%) participants and 11449 (99.00%) of their children in Zhejiang, China had been vaccinated against COVID-19. Children whose parents did not receive COVID-19 vaccination were 19 times (aOR 18.96, 95%CI 12.36-29.08) more likely to be unvaccinated than their counterparts. In addition, children with no previous influenza vaccination, those whose parents doubted the COVID-19 vaccine’s safety or effectiveness, were 6.11 times (aOR 6.11, 95%CI 2.80-13.34), 8.27 times (aOR 8.27, 95%CI 5.33-12.83), and 2.69 times (aOR 2.69, 95%CI 1.11-6.50) more likely to be unvaccinated than their counterparts, respectively. COVID-19 vaccine uptake varied between different sociodemographic groups. However, the odds of receiving the COVID-19 vaccine decreased as age and education level increased. The main refusal reasons claimed by participants were that they had medical conditions that may not qualify them for vaccination (53.78%), followed by safety concerns about the vaccine (13.56%), not knowing where to get vaccinated (6.44%), and concerns about fertility issues (5.56%). Conclusions: Despite a highly encouraging level of COVID-19 vaccine uptake in Zhejiang, China, the elderly and highly educated people had lower COVID-19 vaccine uptake. It is suggested that tailored health education strategies should be taken to increase the COVID-19 vaccine uptake in such groups. Furthermore, with vaccination rates at such a high level, the pandemic is still ongoing, and public confidence in vaccines may decline. Thus, sufficient evidence-based information regarding COVID-19 vaccines should be provided to the public.
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Long-COVID in children and adolescents: a systematic review and meta-analyses
Article
Full-text available
  • Jun 2022
The objective of this systematic review and meta-analyses is to estimate the prevalence of long-COVID in children and adolescents and to present the full spectrum of symptoms present after acute COVID-19. We have used PubMed and Embase to identify observational studies published before February 10th, 2022 that included a minimum of 30 patients with ages ranging from 0 to 18 years that met the National Institute for Healthcare Excellence (NICE) definition of long-COVID, which consists of both ongoing (4 to 12 weeks) and post-COVID-19 (≥ 12 weeks) symptoms. Random-effects meta-analyses were performed using the MetaXL software to estimate the pooled prevalence with a 95% confidence interval (CI). Heterogeneity was assessed using I2 statistics. The Preferred Reporting Items for Systematic Reviewers and Meta-analysis (PRISMA) reporting guideline was followed (registration PROSPERO CRD42021275408). The literature search yielded 8373 publications, of which 21 studies met the inclusion criteria, and a total of 80,071 children and adolescents were included. The prevalence of long-COVID was 25.24%, and the most prevalent clinical manifestations were mood symptoms (16.50%), fatigue (9.66%), and sleep disorders (8.42%). Children infected by SARS-CoV-2 had a higher risk of persistent dyspnea, anosmia/ageusia, and/or fever compared to controls. Limitations of the studies analyzed include lack of standardized definitions, recall, selection, misclassification, nonresponse and/or loss of follow-up, and a high level of heterogeneity.
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Trends in adolescent COVID-19 vaccination receipt and parental intent to vaccinate their adolescent children, United States, July to October, 2021
Article
Full-text available
  • Mar 2022
Introduction There was a five-fold increase in COVID-19 hospitalization case counts among children and adolescents between June and October 2021. However, polls suggest that adolescent COVID-19 vaccination coverage has plateaued in the United States. Methods Using the Census Bureau’s Household Pulse Survey, we assessed trends in COVID-19 vaccination among adolescents ages 12–17 years, parents’ intention to vaccinate their adolescent children, and their reasons for not intending to vaccinate their children from July to October 2021 using a large, nationally representative survey of U.S. households (n = 59,424). Trends in COVID-19 adolescent vaccination coverage, nationally and by sociodemographic characteristics, factors associated with adolescent vaccination status and parental intent to vaccinate their adolescent children, as well as changes in reasons for non-vaccination were examined using regression models. Results Receipt of ≥1 dose of a COVID-19 vaccine among adolescents ages 12–17 years increased five percentage points, from 56% (July) to 61% (October), with significant increases across most sociodemographic variables. However, there were no significant changes in parental intention to vaccinate their adolescent children during the same time period. Approximately one-quarter of parents were unsure about or reluctant to vaccinate their children, which remained consistent from July to October. Among those who had not vaccinated their children, lack of trust in the government and vaccines, and the belief that the COVID-19 vaccine is not needed or effective, was higher in October compared to July. Conclusions Parental intention to vaccinate their children has remained relatively stable throughout the late summer and early fall of 2021. Encouraging paediatricians to discuss the importance and safety of COVID-19 vaccines, addressing concerns and misinformation, as well as recommending and offering vaccines are important for increasing parental confidence in vaccines as well as vaccination uptake among adolescents. KEY MESSAGE Receipt of ≥1 dose of a COVID-19 vaccine among adolescents ages 12–17 years increased five percentage points, from 56% (July) to 61% (October), with significant increases across most sociodemographic variables. Approximately one quarter of parents were unsure about or reluctant to vaccinate their children, which remained consistent from July to October. Encouraging paediatricians to discuss the importance and safety of COVID-19 vaccines, addressing concerns and misinformation, as well as recommending and offering vaccines is important for increasing parental confidence in vaccines as well as vaccination uptake among adolescents.
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Risk factors for poor prognosis in children and adolescents with COVID-19: A systematic review and meta-analysis
Article
Full-text available
  • Nov 2021
Background This study provides the first systematic review and meta-analysis to identify the predictors of unfavorable prognosis of COVID-19 in children and adolescents. Methods We searched literature databases until July 2021 for studies that investigated risk factors for unfavorable prognosis of children and adolescents with COVID-19. We used random-effects models to estimate the effect size with 95% confidence interval (CI). Findings We identified 56 studies comprising 79,104 individuals. Mortality was higher in patients with multisystem inflammatory syndrome (MIS-C) (odds ratio [OR]=58.00, 95% CI 6.39–526.79) and who were admitted to intensive care (OR=12.64, 95% CI 3.42–46.68). Acute respiratry distress syndrme (ARDS) (OR=29.54, 95% CI 12.69–68.78) and acute kidney injury (AKI) (OR=55.02, 95% CI 6.26–483.35) increased the odds to be admitted to intensive care; shortness of breath (OR=16.96, 95% CI 7.66–37.51) increased the need of respiratory support; and neurological diseases (OR=5.16, 95% CI 2.30–11.60), C-reactive protein (CRP) level ≥80 mg/L (OR=11.70, 95% CI 4.37–31.37) and D-dimer level ≥0.5ug/mL (OR=20.40, 95% CI 1.76–236.44) increased the odds of progression to severe or critical disease. Interpretation Congenital heart disease, chronic pulmonary disease, neurological diseases, obesity, MIS-C, shortness of breath, ARDS, AKI, gastrointestinal symptoms, elevated CRP and D-dimer are associated with unfavourable prognosis in children and adolescents with COVID-19.
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What is the evidence for transmission of COVID-19 by children in schools? A living systematic review
Article
Full-text available
  • Dec 2020
Background: It is of paramount importance to understand the transmission of SARS-CoV-2 in schools, which could support the decision-making about educational facilities closure or re-opening with effective prevention and control measures in place. Methods: We conducted a systematic review and meta-analysis to investigate the extent of SARS-CoV-2 transmission in schools. We performed risk of bias evaluation of all included studies using the Newcastle-Ottawa Scale (NOS). Results: 2178 articles were retrieved and 11 studies were included. Five cohort studies reported a combined 22 student and 21 staff index cases that exposed 3345 contacts with 18 transmissions (overall infection attack rate (IAR): 0.08%, 95% confidence interval (CI) = 0.00%-0.86%). IARs for students and school staff were 0.15% (95% CI = 0.00%-0.93%) and 0.70% (95% CI = 0.00%-3.56%) respectively. Six cross-sectional studies reported 639 SARS-CoV-2 positive cases in 6682 study participants tested [overall SARS-CoV-2 positivity rate: 8.00% (95% CI = 2.17%-16.95%). SARS-CoV-2 positivity rate was estimated to be 8.74% (95% CI = 2.34%-18.53%) among students, compared to 13.68% (95% CI = 1.68%-33.89%) among school staff. Gender differences were not found for secondary infection (OR = 1.44, 95% CI = 0.50-4.14, P = 0.49) and SARS-CoV-2 positivity (OR = 0.90, 95% CI = 0.72-1.13, P = 0.36) in schools. Fever, cough, dyspnea, ageusia, anosmia, rhinitis, sore throat, headache, myalgia, asthenia, and diarrhoea were all associated with the detection of SARS-CoV-2 antibodies (based on two studies). Overall, study quality was judged to be poor with risk of performance and attrition bias, limiting the confidence in the results. Conclusions: There is limited high-quality evidence available to quantify the extent of SARS-CoV-2 transmission in schools or to compare it to community transmission. Emerging evidence suggests lower IAR and SARS-CoV-2 positivity rate in students compared to school staff. Future prospective and adequately controlled cohort studies are necessary to confirm this finding.
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Systematic review of COVID‐19 in children show milder cases and a better prognosis than adults
Article
Full-text available
  • Mar 2020
Aim The coronavirus disease 2019 (COVID‐19) pandemic has affected hundreds of thousands of people. Data on symptoms and prognoses in children are rare. Methods A systematic literature review was carried out to identify papers on COVID‐19, which is caused by the severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2), using the Medline and EMBASE databases between 1 January and 18 March 2020. Results The search identified 45 relevant scientific papers and letters. The review showed that children have so far accounted for 1‐5% of diagnosed COVID‐19 cases, they often have milder disease than adults and deaths have been extremely rare. Diagnostic findings have been similar to adults, with fever and respiratory symptoms being prevalent, but fewer children seem to have developed severe pneumonia. Elevated inflammatory markers were less common in children and lymphocytopenia seemed rare. Newborn infants have developed symptomatic COVID‐19, but evidence of vertical intrauterine transmission was scarce. Suggested treatment included providing oxygen, inhalations, nutritional support and maintaining fluids and electrolyte balances. Conclusions COVID‐19 has occurred in children, but they seemed to have a milder disease course and better prognoses than adults. Deaths were extremely rare.
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Measles Resurgence in Europe: Migrants and Travellers are not the Main Drivers
Article
Full-text available
  • Dec 2019
Measles is a highly transmissible viral infection that may lead to serious illness, lifelong complications, and death. As there is no animal reservoir for measles, measles resurgence is due to human movement of viremic persons. Therefore, some have blamed the enormous migration into Europe in the past 5 years for the measles resurgence in this region. We set out to determine the main driver for measles resurgence in Europe by assessing vaccine coverage rates and economic status in European countries, number of migrants, and travel volumes. Data on measles vaccine coverage rates with two vaccine doses of measles, mumps and rubella (MMR) [Measles Containing Vaccine (MCV)2] and total number of measles cases in 2017 for Europe, including Eastern European countries, were obtained, in addition to Gross Domestic Product (GDP), and number of migrants and tourist arrivals. The outcome measured, incidence of measles per 100,000, was log transformed and subsequently analyzed using multiple linear regression, along with predictor variables: number of international migrants, GDP per capita, tourist arrivals, and vaccine coverage. The final model was interpreted by exponentiating the regression coefficients. Incidence of measles was highest in Romania (46.1/100,000), followed by Ukraine (10.8/100,000) and Greece (8.7/100,000). MCV2 coverage in these countries is less than 84%, with lowest coverage rate (75%) reported in Romania. Only vaccine coverage appears to be the significant predictor in the model (p < 0.001) for incidence of measles even after adjusting for international migrants, international tourist arrivals, and GDP per capita. With one unit increase in vaccination coverage, the incidence of measles decreased by 18% [95% confidence interval (CI): 10-25]. Our results showed that number of migrants and international tourist arrivals into any of the European countries were not the drivers for increased measles cases. Countries with high vaccine coverage rates regardless of economic status did not experience a resurgence of measles, even if the number of migrants or incoming travellers was high. The statistically significant sole driver was vaccine coverage rates. These analyses reemphasize the importance of strategies to improve national measles vaccination to achieve coverage greater than 95%.
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Determinants of COVID-19 vaccine hesitancy among parents in Ho Chi Minh City, Vietnam
Article
  • Feb 2022
Background: : COVID-19 vaccines are critical tools to manage the current pandemic. The objective of this study is to assess determinants of COVID-19 vaccine hesitancy among parents in Ho Chi Minh City, Vietnam. Methods: : A cross-sectional study of parents were performed, who had at least one child aged 5-17 years. The data was collected by a self-report questionnaire, which was based, predominately, on the Health Belief Model (HBM), between January 21 and April 20, 2021. The main outcome of this study aims to investigate the self-reported parental COVID-19 vaccine hesitancy for their children that has been approved by health authorities in Vietnam. Results: : A total of 1,015 parents completed the survey. Parental COVID-19 Vaccine Hesitancy for their children (26.2%) was decreased with blue-collar workers, intended to get vaccinated themselves, indicated sufficient knowledge toward COVID-19, and their older children reported having comorbidities. In the HBM structure, the barriers were positively related to parents' hesitancy to vaccinate their children, whilst perceived susceptibility and severity to illness, benefits of vaccination, and cues to action were less likely to cause a refusal of a vaccination for their children (all p<0.05). The reasons for vaccine hesitancy included, predominately, concerns about side effects (81.6%), and vaccine safety (76.3%). Conclusion: : The findings show that almost a quarter of the study population are hesitant to vaccinate their children. Factors were associated with parental vaccination hesitancy for their children include sufficient knowledge of the COVID-19, older children and those with chronic conditions, and domains of HBM like the perception of susceptibility and severity to illness, benefit and barriers of vaccination, and cues to action. These will contribute to make planning in health communication strategies for the upcoming vaccination campaigns, as well as managing the pandemic.
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