Last week, the US Centers for Disease Control and Prevention issued guidelines recommending an updated Covid-19 booster for children ages 5 to 11. Previously, the bivalent booster was recommended for children over 12 years of age, as well as for all adults. Now, the Pfizer/BioNTech booster is available for children 5 years and older, and the Moderna booster is available for children 6 years and older.
What should parents consider when deciding whether to get an updated booster for their child? Are there any circumstances that may encourage families to wait? Are there any downsides? What about children who have just turned 5 – do they need to get a new booster? If a child is not yet vaccinated, are they eligible for an updated booster?
To guide me through these questions, I spoke with CNN medical analyst Dr. Leana Wen, an emergency physician and professor of health policy and management at the Milken Institute School of Public Health at George Washington University. She is also the author of “Lifelines: A Doctor’s Journey in the Fight for Public Health” and is the mother of two young children.
CNN: Who is now eligible for the updated Covid-19 booster? Does it matter how many vaccines they have received before?
Dr. AS Leana Wen: Basically, everyone over the age of 5 can receive the new bivalent booster for Covid-19, as long as they have completed the main vaccination series. It doesn’t matter how many boosters they had. This means that a child who has received only two initial doses of Pfizer or Moderna can receive a booster, as can a child who has already received a booster dose, as long as at least two months have passed since the last vaccine dose.
CNN: What should parents and caregivers consider before choosing an updated booster for their child?
Wen: Two key questions must be asked. First, is your child at high risk of serious illness from Covid-19? The most important reason to get vaccinated is to reduce the chance of hospitalization and other serious consequences. The first two doses of the vaccine are very good for most children to achieve this. However, some may be at greater risk for worse outcomes if the child has serious medical conditions, such as chemotherapy or is a transplant recipient. In these situations a booster dose would be recommended.
Second, is it really important to prevent Covid-19 infection in your children? Many families have decided that by vaccinating their children, if the risk of serious illness is very low, they do not prioritize getting rid of the Covid-19 infection.
On the other hand, others remain very alert and cautious. Maybe they are worried about the unknown about the long Covid. Perhaps they want to avoid their children being sick, causing them to miss school days and work days for caregivers. Or maybe there’s another member to protect, such as an elderly grandparent or someone else with underlying chronic conditions. These are all reasonable considerations for getting kids a booster sooner rather than later.
One thing I will note is that we don’t know how long the booster will be effective in reducing symptomatic infection. Some studies have shown that the effectiveness of the first vaccine against symptomatic infection can wane after a few months. That said, a lot can happen with Covid-19. We could see more cases in autumn and winter. There could be a new variant that becomes dominant. Many parents may want to ensure their children have the perfect protection in case of another surge, and will decide again next year whether another boost is needed.
CNN: Are there situations where families have to wait to promote their children?
Wen: If a child has recently had Covid-19, I think it is recommended to wait at least three months before giving a boost as recommended by the CDC. Re-infection is unlikely during this time frame, and it may be beneficial to give the body time to develop its own immune response.
The same goes for a previous vaccination. The CDC says that children and adults can get an updated booster as long as it’s been at least two months since their last shot.
I think both are minimal ranges. Many experts, myself included, believe that waiting longer (perhaps four or six months) after infection or the last vaccination is beneficial. This longer period of time may allow the body to improve immunity before another boost, as some studies have suggested. However, I understand and appreciate the CDC’s need to simplify the guidelines, and it is reasonable to follow their guidelines as stated.
CNN: Are there any downsides to pushing kids?
Wen: This is an important question to ask. The way I would respond is to clarify that every intervention – including vaccines – has pros and cons. Parents and families will weigh the pros and cons differently. The evidence is very clear that for early vaccinations, the benefits outweigh any potential risks. The evidence is less clear for the proponents.
For a child with serious underlying medical conditions, for example, there is great benefit in getting a booster to prevent serious outcomes from Covid-19. For other children, especially children under 12 years of age, the initial vaccinations are probably still very protective, and it is not yet clear what the additional benefit of the booster is in reducing the risk of hospitalization.
Covid-19 vaccines have some common side effects. The vast majority are benign and self-correcting; Symptoms such as body aches, fatigue, fever and pain around the booster jab site usually disappear within a couple of days. (There are very rare cases of myocarditis, an inflammation of the heart muscle most commonly seen in adolescence. These also resolve on their own and have no long-term consequences.) In general, these should not occur. the main consideration for parents.
The CDC has recommended the booster, and I think it’s reasonable for parents who want to follow the guidance to do so. For those on the fence, having a frank conversation with your pediatrician about your family’s specific circumstances can also guide your decision.
CNN: What about kids who just turned 5 – should they get a new booster?
Wen: I have a son who recently turned 5, and he got his first series when he was 4. His last shot was in July. I don’t plan to give boosters yet. I am waiting at least six months for the reasons mentioned above.
CNN: Can parents and caregivers choose to give their children a dose of the original promotion?
Wen: no The US Food and Drug Administration has withdrawn the authorization of the original monovalent vaccine and replaced it with the updated bivalent booster. This means you can only receive the updated booster. This applies to both children and adults.
CNN: If a child hasn’t been vaccinated yet, are they eligible for an updated booster?
Wen: no Children who have not yet been vaccinated can only receive the original vaccine for their primary series. Parents who want their children to receive the updated bivalent vaccine should complete the main series (two doses of Pfizer or Moderna) and then get the updated booster.
I want to emphasize the importance of the primary series. Numerous studies have found that the first two doses are highly protective against serious illness, including in children. In a New England Journal of Medicine study, the first two doses of Pfizer or Moderna vaccines reduced hospitalizations in children by more than 80%. This should be a call to action for families who have not had their children vaccinated against Covid-19.