An increase in pediatric and adolescent hospitalizations, peaking in January and continuing into March and April of this year, led the U.S. Centers for Disease Control and Prevention to expand efforts to vaccinate eligible teenagers for COVID-19.

These efforts have been confronted with skepticism and concerns over the safety of vaccinating individuals under the age of 18. Currently, the CDC recommends the Pfizer vaccine for individuals 12 years and older. These recommendations are supported by extensive clinical trials and data validating vaccination efficacy and safety in this age group.

Dr. Francisco Garcia, deputy county administrator, stated in the Sept. 21 Board of Supervisors meeting, that schools had reported 2,013 cases during the week of Sept. 13, and all school districts in Pima County have now been impacted by COVID-19. 

To address some common questions raised by parents and community members concerning vaccinations, the Daily Wildcat interviewed Dr. Nathan Price, an associate professor of pediatrics at the University of Arizona College of Medicine, Tucson. As a board certified pediatric infectious disease expert, Price draws from his experience and expertise to address the similarities and differences of COVID-19 infection in children and adults, the rise of the Delta Variant and the importance of vaccination.

Daily Wildcat: How do COVID-19 symptoms differ between pediatric and adult patients?

Nathan Price: “There really is not a big difference. When kids and teens get sick with COVID-19 they have similar symptoms as adults. These include cough, runny nose, body aches, fever and fatigue. When infection progresses and pediatric patients get really sick, their symptoms still resemble those of adults. A recent study showed that one third of pediatric patients admitted to the hospital as a result of COVID-19 are transferred to the ICU. We see the same pattern in adults. In short, pediatric patients can get just as severely ill as adults. Thankfully, the percentage of ill and severely ill pediatric patients in the U.S. is much lower than that of adults. This is because when kids and teens get infected, they are less likely to get sick with symptoms and have disease progression.”

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DW: Why are pediatric populations less likely to get infected with COVID-19?

NP: “There are many theories being explored but nobody really knows right now. Some researchers suggest that children have modified or different numbers of ACE 2 receptors, one of the primary cellular receptors that allows SARS-CoV-2 to infect the body. Others suggest children exposed to more recent viral infections not common in adults may have a certain degree of immunity against COVID-19. Others speculate that the immune response to COVID-19 in children has less collateral damage to the body when compared to adults. As of right now, nobody truly knows.”

DW: Are pediatric patients more susceptible to the COVID-19 delta variant?

NP: “There is ongoing research on this topic but presently we cannot say definitively that the delta variant is worse for children than adults. However, researchers and clinicians suggest that the delta variant is doing a better job of infecting people in general. Since more people are being infected with delta collectively, more children are being infected than before. Another important thing to consider is the role of vaccination. More adults are vaccinated against COVID-19 than children. Meaning that there is more protection against the virus in the adult population. So, the comparative increase in pediatric infection is not a result of the delta variant being worse in children, but instead a result of decreased vaccination in the pediatric population.”

DW: What factors put children and adolescents at higher risk of COVID-19 infection and disease progression?

NP: “In general, things like obesity, diabetes, and immune suppression from prior disease or a hereditary disease will increase risk. However, the reality is that healthy individuals without these comorbidities can still get infected and some unfortunately die from COVID-19. So, the best way to prevent illness and severe illness is to get vaccinated, maintain social distancing, wear a mask and keep a safe distance from infected individuals. If we take these steps, we can break the chain of disease, fewer people will get infected and fewer children will die.”

DW: What vaccine is available for pediatric populations?

NP: “Right now, the Pfizer vaccine is the only vaccine in the United States that has received Emergency Use Authorization for children between the ages of 12 to 15. For ages 16 and up the Pfizer vaccine has received full FDA approval. Now, it is important to understand that Emergency Use Authorization for a vaccine requires extensive research that supports safety and efficacy. It is still a rigorous process, but it allows for a vaccine to be available to the public when there is an emergency. As for a vaccination for ages 5 through 11, Pfizer has recently submitted data on clinical trials and the FDA is evaluating this data for safety and efficacy. Once they fully evaluate this data, they can approve the vaccine for this age group. We expect that this process will show similar results in efficacy and safety that we have seen in the past and that the vaccine will be approved for Emergency Use Authorization soon for this group. Hopefully within a month or so. For the 6-month to 4-year-old age group more studies and data need to be evaluated before a formal review by the FDA.”

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DW: Are vaccine side-effects in children and adolescents different than in adults?

NP: “At this point in time, we have not seen any major differences. In general, both groups may experience headaches, fever, arm pain, fatigue and some body aches, but again these are minor side-effects and many individuals do not experience these at all. In the end, people are filling up our hospitals because of COVID-19 infection and disease, not because of adverse side-effects to the vaccine.”

DW: What do you say to parents who are hesitant about vaccinating their children because of safety concerns or limited research?

NP: “Parents want to do what is safe and helpful for their family. I do not think there is anybody out there who is hesitant about vaccines because they want to hurt their child. Generally, people make these decisions based on the information that they have. As a physician, I do my best to inform parents on the risk of vaccinating versus the risk of not vaccinating. At the end of the day, the best way to avoid the most risk is to get vaccinated. Like anything, there are some risks associated with vaccination, but these are far lesser than the very real risk of contracting COVID-19. When I look at children specifically and the way the vaccine was made available to them, I have to emphasize that no corners were cut. No other vaccine in history has had the degree of evaluation and scrutiny for safety and efficacy than the COVID-19 vaccine. Around 360 million vaccines have been administered in the United States and about six billion around the world. We now have substantial data that shows time and time again that risk of infection and disease far outweighs the risks of the vaccine in both children and adults.”

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