THE College of Paediatrics (CoP), Academy of Medicine of Malaysia, in collaboration with experts from various paediatric subspecialties and public health, strongly support our government’s initiative to roll out the National Covid-19 Immunisation Programme for children of ages 5-11.
The approved Pfizer-BioNTech vaccine schedule consists of two 10mcg doses (in contrast to the 30mcg dose for those aged 12 and above) to be administered at least 21 days apart.
To date, successful roll-outs of mass vaccination programmes for adults and adolescents have demonstrated a significant reduction in the cases of attack rates, risks of infection, and disease burdens, allowing for a safer reopening of economies and a notable decrease in the pandemic’s devastating impact on healthcare systems.
However, to achieve herd immunity and enter the endemic phase, there is a necessity to bridge the gap of vaccination between different populations regardless of their age and socio-economic differences, focusing now on children who are largely unprotected.
The emergence of the highly transmissible Omicron variant is highly concerning. Reports indicate that children infected with the Omicron variants have a 20% higher risk of hospitalisation compared with the Delta variant.
In the United States, paediatric Covid-19 admissions rose by 48% during the final week of December alone. Many of these children were unvaccinated or under-vaccinated. Of importance is the development of the multisystem inflammatory syndrome in children (MIS-C) in some who contract Covid-19.
The long-term consequences and profile of MIS-C and “long Covid” are not fully defined, thus its negative clinical impact may potentially increase in tandem with the rising Omicron infections.
Jab drives for kids
The CoP urges the government to ensure a meticulously executed vaccination programme for children below 12 years old in Malaysia. This is crucial especially when the country is faced with an increased Covid-19-related mortality rate in children.
From July to December last year, 105 deaths were reported among children 0 to 17 years old. The disease or the fear of it also results in limited school activities and social interactions that are detrimental to normal childhood development.
Evidence from Phase 2 and 3 clinical trials and real-world experience have demonstrated that Covid-19 vaccinations are effective and safe for younger children and adolescents. As of November last year, more than 100 countries have either commenced or are planning to expand Covid-19 vaccinations to children, starting with adolescents (12 to 17 years old), including Malaysia.
Reports of post-vaccination acute myocarditis/pericarditis among the vaccinated adolescent group have raised some concerns. In view of this, some countries resorted to a single-dose vaccine instead of the two-dose schedule for adolescents.
However, post-vaccination myocarditis is mild and conservative management is adequate. Studies are needed to determine if the omission of the second dose results in a significant reduction in post-vaccination myocarditis without compromising the level of protection against Covid-19.
We note that in the United Kingdom, the single-dose schedule was updated to two doses recently. This was based on increasing evidence demonstrating the substantially lower risk of post-vaccination myocarditis compared to Covid-19-related myocarditis, and the increased dosing efficacy that is required to overcome the Omicron variant.
The US Centres for Disease Control and Prevention published the safety profile of 8.7 million doses of the Pfizer-BioNTech Covid-19 vaccine given to children 5 to 11 years old, reporting predominantly local or systemic reactions and only 11 cases of non-fatal myocarditis.
In line with global data and our local vaccine safety study (SafeCovac), the findings to date indicate that post-vaccination myocarditis events are rare, and that most of the cases are mild, self-limiting, and spontaneously resolved.
The Covid-19 pandemic is still evolving with the emergence of new variants. This highlights the urgency in maximising the protective benefits of vaccination across all age groups, especially children.
Based on the published safety profiles and mounting evidence of the benefits from Covid-19 vaccination, the CoP unequivocally recommends the vaccination of children, especially schoolchildren, aged 5 and above. – The Vibes, January 26, 2022
Signatories:
Prof Dr Cheah Fook Choe, senior consultant neonatologist and CoP vice-president
Prof Dr Thong Meow Keong, consultant paediatrician and CoP president
Prof Datuk Dr Zulkifli Ismail, consultant paediatrician and paediatric cardiologist
Prof Dr Zilfalil Alwi, consultant paediatrician and clinical geneticist
Dr Amir Hamzah Abdul Latiff, consultant paediatrician and paediatric immunologist
Dr Patrick Chan Wai Kiong, consultant paediatrician and respiratory physician
Assoc Prof Dr Erwin Khoo Jiayuan, consultant paediatrician and paediatric bioethicist
Prof Dr Noran Naqiah Hairi, epidemiologist and public health medicine specialist
