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A New Vaccination Strategy for Children: Only One Dose for Now


While parents in the United States grapple with the difficult questions of vaccinating their children against the coronavirus, families in other countries have been presented with a new option: giving children just one dose of the vaccine.

Authorities Hong Kong As in England, Norway and other countries They recommended a single dose of Pfizer-BioNTech vaccine for children 12 years and older – providing partial protection from the virus, but without the potential harm sometimes observed after two doses. On Wednesday, Sweden and Denmark joined the ranksannounced that adolescents should receive only one shot of the Moderna vaccine.

Health officials in these countries are particularly concerned by the growing data suggesting that myocarditis, an inflammation of the heart, may be more common among adolescents and young adults after vaccination than previously thought.

The risk remains very small and is significant only after the second dose of mRNA vaccine. But the numbers have changed the risk-benefit calculation in countries where new infections are mostly lower than in the US.

Advisors to the Centers for Disease Control and Prevention reviewed data on myocarditis in June and unanimously agreed to recommend the vaccine for children 12 years of age and older, saying the benefits far outweigh the risk.

Agency research found that for every million vaccinated boys ages 12 to 17 in the United States, vaccines are maximum of 70 cases of myocarditisbut they would have prevented 5,700 infections, 215 hospitalizations and two deaths. Studies have also shown that the risk of heart problems after Covid-19 is much higher than after vaccination.

Myocarditis was among the concerns that prompted the Food and Drug Administration to ask vaccine manufacturers this summer to increase the number of children in clinical trials. The issue will likely be the focus of intense discussion as agency consultants meet next week to review the evidence for vaccinations for children aged 5 to 11 years.

The most recent analysis, published Wednesday in The New England Journal of Medicine, found an incidence of myocarditis after vaccination in Israel. was highest among men aged 16 to 29. About 11 out of every 100,000 men in this age group developed the condition a few days after they were vaccinated; this is a higher rate than most previous estimates. (For women of all ages, the risk was negligible.)

One of the 54 cases identified in the study was severe enough to require ventilation. Another patient with a history of heart disease died of unknown cause shortly after discharge from the hospital.

In the new study, 10 of the 14 patients who showed heart abnormalities when they were hospitalized still had some signs of trouble when they were discharged. However, when the patients were re-examined a few weeks later, all five people with results had fully recovered.

A second study, also published in the journalism, found that boys aged 16 to 19 had the highest incidence of myocarditis after the second dose – nine times higher than unvaccinated boys of the same age. .

Health officials in other countries plan to reconsider the single dose strategy as more safety information becomes available and may choose to continue with second vaccines. But a drug safety expert at the University of Pittsburgh, Dr. Walid Gellad said the possibility of delaying the second vaccine has not received enough attention in the US.

Dr. “People in the US didn’t want to talk about it for unclear reasons,” Gellad said. Hesitant parents may appreciate the fact that the risk of side effects is actually much lower for one dose than for two doses.”

Serious side effects were seen primarily in boys, so the dosing calculation for boys and girls should be different, he added.

A respiratory disease specialist at University College London and a member of the UK’s vaccine advisory group, Dr. It’s too early to know if myocarditis can permanently weaken the hearts of some people after vaccination, Jeremy Brown said.

Dr. “This makes it very difficult for us to make an absolute statement that it is perfectly safe to give this vaccine,” Brown said. “We need some insight into what the long-term consequences of myocarditis might be.”

The urgency of fully vaccinating children with two doses should be weighed against each country’s specific situation, experts said. High vaccination rates among older and high-risk adults in the UK have helped keep hospitals mostly away from patients with severe Covid-19.

Dr. “In a healthy 12 to 15-year-old child, the chance of contracting severe Covid is almost negligible,” Brown said. “As against that, you have to make sure that the vaccine you give is completely safe.”

Some experts argued that vaccinating children would help break the chains of transmission and contain the virus. However, Dr. Brown said that immunizing children to protect others—where there might be a risk, no matter how small, for the recipient—is untenable.

“You’re not vaccinating a 15-year-old to prevent him from infecting other adults – that’s not the morally and ethically right thing to do,” he said.

Benjamin Cowling, an epidemiologist at the University of Hong Kong, said the argument for double-dose adolescents in Hong Kong is even weaker than in the UK.

Hong Kong has recorded only 213 deaths and more than 12,000 cases of Covid-19 since the start of the pandemic, while fewer than 10 cases per day have been recorded since April. Dr. Therefore, although rare, the risk of myocarditis outweighs the benefit of fully vaccinated adolescents, Cowling said.

Clinical trials of the vaccine in children are not large enough to detect rare side effects such as myocarditis, he added. “You would only see it when it was down to the population level, and then it would be too late.” Whether to give a second dose to children “needs careful consideration”.

But as an infectious diseases physician and a non-voting member of the CDC’s advisory group on vaccines, Dr. Jeffrey Duchin stated that the United States is not in the same position as other countries.

About 2,000 Americans die every day, and hospitals in many parts of the country are still full. Dr. “We have had a significant impact on our pediatric population,” Duchin said.

Nearly 900,000 children have been hospitalized with Covid-19 since the pandemic began, and about 520 have died. Some children developed the so-called long Covid-19, where symptoms can last for months, and more than 4,000 children have been diagnosed with a dangerous condition called multisystem inflammatory syndrome in children.

Dr. “All the data we have so far suggests that the disease itself is significantly worse than the vaccine side effects,” Duchin said. Given all this, it’s worth taking a small risk of myocarditis, he said, and two doses are justified.

Dr. Duchin also said he has some concerns that a dose of the vaccine might not protect children against infection or illness — at least not for long. “I have not seen data showing that a dose would be durable and have a high level of protection,” he said.

Some experts said all these concerns, along with the data on myocarditis, should inform a national conversation about the wisdom of offering adolescents two shots instead of one.

Dr. “There hasn’t been enough discussion about the potential harms of vaccination because not everyone is too sensitive to hesitation and doesn’t want to fuel anti-vaccine campaigns,” Cowling said.

Dr. Many public health professionals, particularly in the United States, have been reluctant to voice their concerns about vaccines, Gellad said: “Nobody wants to raise any suspicions that children should be vaccinated.”

“But I think there are ways of speaking that will appeal to people who are hesitant about it.”

Kristina Rogers, a 51-year-old mother of two in Oklahoma, said she would welcome the option of giving her 12-year-old daughter just one dose of the vaccine.

Ms. Rogers, who is fully vaccinated, worries that not enough is known about the long-term effects of vaccines on children and said she wished there was a more open discussion.

Ms. Rogers has diabetes and developed chronic kidney disease after suffering a severe Covid crisis last year. She lost her brother-in-law to Covid a year ago.

But both doses of the vaccine left her feeling dizzy and tired, and she worried that the vaccines might be too much for her children. Her children wear masks to school and wash their hands regularly, but she and her husband are not yet ready to vaccinate them.

“The last thing you want to do is disrupt their moves, man – that’s what moves them,” he said. “If that was an option, I would be more for a single dose.”



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