By Marie Rosenthal, MS

Shortly after a unanimous recommendation by the CDC’s Advisory Committee on Immunization Practices (ACIP), the CDC endorsed the ACIP’s recommendation that all children 6 months of age and older should be vaccinated against COVID-19. 

Earlier in the day, the ACIP panel members recommended that children as young as 6 months of age receive either the Moderna or Pfizer-BioNTech messenger RNA vaccine. 

Until this vote, vaccination was recommended for people at least 5 years of age. This expands COVID-19 vaccine eligibility to nearly 20 million more children.

“I want to make it [the recommendation] certain for parents and for the public that we recommend this vaccine,” said ACIP member Sarah Long, MD, a pediatric infectious disease specialist at Children’s Hospital of Philadelphia. “All children 6 months and older should be immunized against COVID-19. We talk a lot about the safety, and we talk a lot about the data, and we may lose the notion that we are in the business of saving children’s lives. 

“It’s outrageous that 200 children have died and more will, and we can prevent this,” she added. “I think we want to emphasize that this is to protect individual children from hospitalization and death.”

Dr. Long added that in her long career, her decisions have saved children’s lives, “but I have the ability with a vote today to save more lives than my particular decisions in extremely sick children have saved throughout my career.” 

Speaking at the ACIP meeting, pediatrician Yvonne “Bonnie” Maldonado, MD, FAAP, the chair of the American Academy of Pediatrics Committee (AAP) on Infectious Diseases, emphasized the importance of these vaccines for the youngest members of society, who have waited the longest for this protection.

“Pediatricians know the power of vaccines to protect infants, children, adolescents and entire communities against deadly and debilitating infectious diseases,” Dr. Maldonado said. “We’ve successfully immunized millions of children and adolescents to protect them from COVID-19. Families with infants and toddlers need and deserve the same chance to protect their children against this virus.”

Children With COVID-19

In a two-day meeting, the ACIP committee members were reminded that COVID-19 has not been a benign disease for all children. 

In fact, COVID-19 was among the five leading causes of death in children from March 1, 2020, to April 30, 2022, and the one that was an infectious disease. Accidents (primarily involving cars or guns) at 1,149 are the leading cause of death; followed by congenital malformations, deformations and chromosomal abnormalities (416); malignancies (285); homicides (284); and COVID-19 (134), according to Sara Oliver, MD, MSPH, a pediatric infectious disease expert, who is a medical officer in the Division of Viral Diseases at the CDC’s National Center for Immunization and Respiratory Diseases. She is also the lead for the COVID-19 Vaccine Safety Technical Work Group, and provided an update to the committee prior to the vote.

To put the deaths into perspective, Dr. Oliver compared the deaths from other vaccine-preventable diseases that became part of the vaccination schedule. Prior to vaccination: 

• COVID-19 caused 86 deaths in those 6 months to 4 years of age between January 2020 and May 2022;
• rubella averaged 17 deaths per year among all ages;
• varicella averaged 16 deaths per year among those 5 to 9 years of age;
• meningococcal disease averaged eight deaths per year among 11- to 18-year-olds;
• rotavirus averaged five deaths per year in children younger than 5 years of age; and
• hepatitis A averaged three deaths per year in people younger than 20 years.
  

In addition, she said, hospitalizations were up among children, especially during the omicron wave of COVID-19—even among children who were previously infected. Reinfection was more likely to occur in unvaccinated people compared with those who were infected and vaccinated, she said. The reason could be that COVID-19 vaccine induces a broader neutralizing antibody response compared with infection-induced immunity, Dr. Oliver explained.

More than half of hospitalized children between 6 months and 4 years of age did not have an underlying condition, according to Katherine E. Fleming-Dutra, MD, a pediatric emergency specialists at Children’s Healthcare of Atlanta. The severity of illness among young children who were hospitalized with COVID-19 during the omicron wave was similar to or worse than that experienced by older children and adolescents.

“The burden of COVID-19 hospitalization is similar to or exceeds that of other pediatric vaccine-preventable diseases,” she said.

Dr. Fleming-Dutra included a discussion about the 8,525 people who suffered multisystem inflammatory syndrome in children (MIS-C) after a COVID-19 infection between Feb. 19, 2020, and May 21, 2022. Among them, 69 children died from MIS-C.

In addition, children are suffering from long-COVID and reporting a range of new, returning or ongoing health problems, she said. Children from 0 to 5 years of age with SARS-CoV-2 infection are more likely to suffer fatigue, loss of taste and loss of smell lasting more than four weeks after the acute infection than those who were not infected with COVID-19.

As of June 12, COVID-19 has caused more than 570,000 cases among infants younger than 12 months and more than 1.9 million cases among children 12 months to 4 years of age, according to Dr. Fleming-Dutra.

“The omicron surge in the United States led to the highest numbers of COVID-19 cases, emergency department visits and hospitalization rates seen during the pandemic,” she added.

The Moderna vaccine in younger children will be given as a two-dose series of 25 mcg for children from 6 months to 5 years of age. The Pfizer-BioNTech vaccine will be given as a three-dose series of 3 mcg for children from 6 to 4 years of age. Both vaccines are given intramuscularly.

Daniel P. McQuillen, MD, the president of the Infectious Diseases Society of America called the recommendation a "significant public health milestone."

"With this authorization, parents of very young children can now have the peace of mind that comes from knowing that their kids can access the best line of defense against this virus, which is still a major public health concern," Dr. McQuillen said.

“Together, with science leading the charge, we have taken another important step forward in our nation’s fight against COVID-19,” said CDC Director Rochelle P. Walensky, MD, MPH. “We know millions of parents and caregivers are eager to get their young children vaccinated, and with today’s decision, they can."

She encouraged parents and caregivers to talk with their doctors, nurses or local pharmacists about vaccinating their children. 

More work remains to vaccinate older children and adolescents, as well. As of June 8, more than 23 million children ages 5 to 17 have received two doses of COVID vaccine. Another 26 million in this age group have yet to receive any doses, according to the AAP.