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When Joshua Ishal gave his 5 and 7-year-old daughters the first dose of Covid-19 vaccine in Queens last week, millions of parents joined in protecting their 5- to 11-year-olds. The Pfizer-BioNTech vaccine was approved for this age group in late October.

Great Neck, NY-based dentist Dr. Diarrhea never questioned whether she should get her children vaccinated, but was hesitant about the timing of their second vaccination.

Clinical trials testing the Pfizer vaccine split doses over three weeks, so the U.S. Centers for Disease Control and Prevention recommends this interval. But emerging data shows that a longer wait strengthens the immune response in the long run. What’s more, the extra time may reduce the risk of myocarditis (heart inflammation), a rare but serious side effect of mRNA vaccines in adolescents and young adults.

Health authorities in Canada recommend that children wait at least eight weeks between doses. In England, children wait 12 weeks for the second shot.

Still, the potential benefits of waiting for the second dose must be balanced against the real risks of contracting and spreading Covid while waiting. The United States is on the verge of another major wave of cases, and new Omicron variant spreading fastDelaying means leaving children vulnerable to infection and illness longer.

“I think it’s a tough decision,” said Aubree Gordon, an infectious disease epidemiologist at the University of Michigan’s School of Public Health.

Is it more important for children to have good protection sooner? Or better, more permanent protection later on? Riddle, Dr. It reminds Diarrhea of ​​an episode of Seinfeld where Jerry tells a story about choosing a cold medicine from a wall of options at the drugstore. “This is fast moving, but this is longevity,” said Jerry. “When am I supposed to feel good, now or later?”

Trish Johnson, a financial advisor in Oakland, California, plans to withdraw her son’s second dose to six or even eight weeks. He said he was swayed by studies showing that a longer interval between doses led to a better immune response.

“I’ve made it my mission to follow doctors on Twitter and do my own research, especially in this later part of the pandemic,” he said. Almost two years after the outbreak, he thinks public health officials have taken too many precautions and cannot adapt to changing data. “This no longer works for me,” he said.

Most experts agree that three weeks between doses is too short an interval for an optimal immune response.

“From an immunological point of view, it makes more sense to wait,” said Deepta Bhattacharya, an immunologist at the University of Arizona. Pfizer didn’t choose three weeks between doses because that’s the perfect range. This decision was “more about public health and reducing community transmission and getting this process done quickly,” he said. Dr. Bhattacharya plans to delay a second dose for her children for up to eight weeks.

The immune system needs time to ramp up after this first dose. Immune cells in the blood, known as B cells, can start producing antibodies within a week. But to produce truly high-quality antibodies, these cells have to go through an intense training camp inside the lymph nodes, which takes more than three weeks.

“You need these B cells to sweat a little bit,” said Andrés Finzi, an immunologist at the University of Montreal.

Most of the research on the different dosing ranges comes from countries like Canada and the UK, which chose to wait for the second vaccine for adults where vaccine doses were scarce last winter and spring. Dr. Finzi and colleagues studied the immune response in 26 people who had their second vaccination three months or more after their first. They also looked at the responses of 12 people who got their shots four weeks apart. The two groups produced roughly the same amount of antibodies, but the group with a longer interval between doses produced stronger antibodies that had a greater capacity to attach to and stay in the virus.

UK authorities extended the dosing interval for all vaccines to 12 weeks last December. Researchers at the University of Oxford studied hundreds of healthcare workers who received a second dose before or after this policy went into effect.

They Research He found that people who waited 10 weeks between their first and second dose had about twice as much antibody levels as those who waited only three or four weeks. These antibodies are produced by B cells that continue to develop over this long range.

“It seems that giving the second dose at three to four weeks is a little early for your B cells to be ready to receive this boost,” said Susanna Dunachie, an immunologist at the University of Oxford who led the study. What’s more, the longer dose range also affected T cells, which helps boost the body’s immune response. After the long hiatus, the study participants’ T cells produced greater amounts of interleukin-2, a chemical signal that aids in long-term immune memory.

Dr. “We were pretty surprised,” Dunachie said.

However, he added that a stronger immune response measured in the lab does not necessarily translate into better protection in the real world.

Results on this are mixed. surveillance data Researchers from British Columbia and Quebec suggest that a longer dose interval improves the effectiveness of the vaccine, according to a study that has not yet been peer-reviewed. That is, people who stayed longer between doses had a lower risk of becoming infected than those who chose less time.

But research from the UK is not so clear. One found modest benefit of delaying the second dose. Two other studies found no effect.

The effect of dose intervals on the risk of myocarditis is even more unclear. in one ResearchResearchers, who have yet to undergo peer review, reviewed Ontario’s vaccine safety surveillance data and identified 297 cases of inflammation in the heart muscle or outer membrane of the heart after vaccination in people 12 years of age and older. Of these, 207 occurred after the second dose. Rates were higher for those who separated their vaccines for a month or less, compared to those who waited six weeks or more.

Whether the vaccine can trigger excessive myocarditis in 5 to 11 year olds remains to be seen. To date, more than seven million doses of the vaccine have been administered to this age group in the United States, and only 14 possible cases of myocarditis have been reported to the government.

The risk of myocarditis is much higher among young men and young men: approx. 11 cases According to one study, a second dose for every 100,000 men aged 16 to 29.

This worries Lisa Rollins, a software instructor in Fredericksburg, Virginia. He turned 12 in early December after his son took his first dose. He plans to wait six weeks to get his second chance. She’s doing virtual learning for now, she and her husband are working from home, and the rest of the family is fully vaccinated. “The risk is pretty low,” Ms Rollins said. “It makes sense for us to wait a little longer.”

Scott Hensley, an immunologist at the University of Pennsylvania Perelman School of Medicine, points out that we have yet to measure how much benefit children might see from waiting a few weeks. Her children received their second dose four weeks after the first.

Dr. “If it weren’t for an epidemic, the answer would be simple – the longer the better,” Hensley said. But “we are at a point in time in the United States where Omicron will sweep our nation and possibly the entire world. So there’s never been a better time to get vaccinated.”

This is Dr. An argument that Ishal finds increasingly convincing. Cases are on the rise in New York. The city-run immunization facility in Queens, where she got her daughters their first vaccinations, took second-dose appointments for three weeks. Given what’s going on at Omicron, it might hold the time frame.

“We’re going to take all the protection we can get right now,” he said. “I think I just decided.”