The number of infections is rising rapidly, especially among children – and so far, not even 20 percent of five- to eleven-year-olds have been vaccinated at least once. Currently, the incidence is more than 3000 cases per 100 000 people. However, the dynamics of the omikron wave give rise to fears that in the foreseeable future the only alternative to vaccination will be infection. In November, pediatricians were still cautious about vaccinating five- to eleven-year-olds. How has the data situation changed since then?
So far, the STIKO only recommends vaccination in this age group for risk groups, but enables vaccination for all parents and children who want this. "In Germany, the STIKO is our specialist body for the vaccination recommendations and makes thorough decisions because it is very careful and weighed up," says Jörg Dötsch, President of the German Society for Pediatric Medicine and Director of the Clinic and Parliamentary Loading Medicine , University Hospital Cologne. "It is very good that she gives parents the opportunity to choose vaccination - we as pediatricians respect both decisions."
Recently, physicians from various disciplines have pleaded in a statement to finally better protect children from infections, including Julian Schmitz, Professor of Clinical Child and Adolescent Psychology at the University of Leipzig, Joachim Riedel, Medical Director at the Werner Otto Institute for Pediatrics and Adolescent Medicine in Hamburg, and Jana Schroeder, Chief Physician for Infectiology at the Mathias Hospital in Rheine. "The vaccinations of children should be carried out efficiently, offered low-threshold and advertised in the sense of a vaccination campaign," it says.
How many kids are actually sick?
Christian Drosten had also recently criticized the organized pediatricians. "The situation in the school operation, since of course the pediatric, pediatric specialist groups, professional associations, professional societies have really exerted their influence over a long time," he said in the corona virus update of the NDR. "And what we have now, both that the vaccination rate is as it is, and not higher, and that the school operation is relatively unrestricted with high numbers of infections and many parents with great concerns, is due to this."
At the beginning, an unusually large number of children were hospitalized with Omikron in South Africa, and then in the UK in December. "The individual risk of severe courses has also decreased in children due to Omikron," says Jörg Dötsch. "But if there are ten times more infected than before, hospitalizations will still increase." Meanwhile, data from England show that the hospitalizations between Delta and Omikron do not differ significantly. A slightly higher proportion of children under the age of five are admitted with Omikron, with Delta older children came to the hospital more often.
At the same time, the recordings on the intensive care units due to severe courses. New studies from the United States show that under the Omikron wave the number of children shot up in some places that had the respiratory symptoms (cough up to shortness of breath). This affects children from half of up to three years. The reason is probably that in contrast to previous variants, Omikron increases in the upper respiratory tract. These are more susceptible to smaller children because they are finer.
Many parents fear PIMS
However, the acute consequences are not what most parents are afraid of. On the one hand there is pims ("pediatric inflammatory multisystem syndrome") or MIS-C ("multisystem inflammatory syndromes in children"). It usually occurs three to six weeks after Sars-Cov2 infection survived. The main symptoms are sudden, very high fever and inflammation of the internal organs. Even if a child had no covid symptoms, it can develop this complication. In Germany, around 660 cases were reported in the corresponding register, probably the actual number is somewhat higher. More than half of the children have to go to the intensive care unit. Children without a previous illness are particularly affected, in the end it worked in some places as if the number of cases staired parallel to the number of cases.
"These are children who are seriously ill, about half of them have to be treated in the intensive care unit," says Johannes Trück, pediatric immunologist at the University Hospital Zurich. "Most recover completely, but some may have problems in the longer term." Above all, the consequences on the heart in later life are still unclear. "Compared to adults, the severe courses in children may be rare," says Trück. "But because there are so many infections in the pandemic, we still see severe progressions." He compares the frequency with infection with meningococci, bacteria that can cause severe meningitis. In Germany, there were 257 cases of severe meningococcal infections in 2019 and 138 cases the following year – and most parents have their children vaccinated against this.
The pediatricians were initially skeptical about the covid vaccination for children because it was not yet clear whether they actually prevent pims. However, this is now becoming increasingly clear, for example in the first study from France: from 107 children with pims, none had never been vaccinated, seven children had only vaccination. An evaluation of the US disease authority CDC showed that the vaccine from Biontech/Pfizer-the only one who is currently approved for children-protects 12 to 18 year olds from pims. At the time of data collection, vaccination was not yet approved for younger people.
It's unclear how many kids contract Long Covid.
Then there is Long Covid. How many infected children will be handicapped in the long term is not yet clear. The definition is out of focus, often the studies lack a control group of children who were not infected, and the symptoms of mental stress due to pandemic with those of Long Covid overlap. However, there are studies that come from 2 to 13 percent. The study results are disputed. But even if only a small percentage of children and adolescents Long Covid developed - a lot of them are currently being infected, so a considerable number of them could be affected in the end.
Data from Israel suggests that the vaccine protects many people from Long Covid. Many parents wonder why they should risk turning a child full of energy and joie de vivre into one that can no longer bring itself to anything. "Yes, it is much rarer, but there is also long Covid in children," says Onur Boymann, Director of the Department of Immunology at the University Hospital Zurich, who researches the topic of long Covid. Whether children are vaccinated is ultimately an individual benefit-risk assessment.
What is new about possible risks from vaccination? An evaluation of 8.7 million vaccinations for five to eleven-year-olds from the USA- almost no serious side effects. "The risk of cardiac muscle inflammation after the second vaccination is a factor of 10 lower than the 12- to 15-year-olds," says Jörg Dötsch.
There is much to be said for childhood vaccination
"A lot speaks for the vaccination in this age group." The risk of myocarditis in the male children infected with Sars-Cov-2 was already six times higher in the 12- to 20-year-olds than after a vaccination. And this comparison is decisive for such a high infection, where no child will get around an infection sooner or later.
"Is it safer to expose yourself to an unpredictable dose of virus with a natural infection or to expose yourself to a clearly defined dose of a vaccine?" asks immunologist Onur Boyman. "The benefit-side effect profile of vaccination is very positive. Vaccination in children makes sense."
But how well does it protect? According to phase III study, the preparation of Biontech/Pfizer had a 90 percent effectiveness against a symptomatic infection with SARS-COV-2. Protection against infection is worse against the omikron variant. Preliminary data from Israel showed in January that 47,000 of the 53,000 infected children were unvaccinated, but the protective effect against Omikron was about 50 percent. The children's vaccine is likely to work against severe courses, because even at older age they hardly have to be instructed to the hospital. So none of the children recorded in the Israeli study was critical due to an omicron infection.
