What parents should know about Covid vaccine boosters for children 5 years and under | CNN

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Last week, the US Food and Drug Administration authorized the use of a bivalent booster Covid-19 drug for children ages 6 months to 5 years. The booster has since been recommended by the US Centers for Disease Control and Prevention, and now everyone 6 months and older can receive the updated coronavirus vaccine except for children who have received three doses made by Pfizer/BioNTech.

Which young children are now eligible to receive the booster? What if children have not started or completed the full series – do they now get the updated booster vaccine or the original monovalent vaccine? Can parents and guardians choose between the updated augmented shot and the original shot? What are the possible side effects? What if the children already had Covid-19? And which families should consider the updated boost now and who can wait?

To help us answer these questions, I spoke with CNN medical analyst Dr. Leana Wen, an emergency physician, public health expert, and professor of health policy and management at George Washington University’s Milken Institute of Public Health. She is also the author of Lifelines: A Doctor in the Fight for Public Health and a mother of two, ages two and five.

CNN: Let’s start with what just changed in the recommendations: Which young children who received the Pfizer or Moderna vaccine are now eligible to receive the booster drug?

Dr.. Lena Wen: There are two approved vaccines for young children: Moderna and Pfizer. For the younger age group, the Moderna vaccine is designed to be a two-dose primary vaccine, while the Pfizer version is designed to be a three-dose primary vaccine. This means that young children are considered to have completed their primary series if they complete two doses of the Moderna vaccine or if they complete three doses of Pfizer.

As a reminder, there is now a bivalent booster available for older children and adults. This combines the original vaccine (also known as the monovalent vaccine) with a vaccine that specifically targets the Omicron subtype BA.4 and BA.5 variants. Since the Omicron sub-variants make up virtually all new infections, the hope is that the bivalent booster will provide better, more targeted protection.

What federal health officials have said now is that children ages 6 months to 5 years who received two doses of the original Moderna vaccine can get the updated bivalent vaccine — if it has been at least two months since they completed the initial vaccine series.

For children who have had the Pfizer vaccine, the instructions are a bit different, because the initial series already includes three doses. Federal health officials said that children between the ages of 6 months and 4 years who have not completed the three doses of the vaccine can receive the third dose as the bivalent vaccine. Suppose a child starts this series and takes one or two doses of the original Pfizer vaccine. The third potion can now be the updated potion.

CNN: What if children don’t start or complete the full series – do they now get the updated booster vaccine or the original monovalent vaccine?

Wen: The answer varies between Moderna and Pfizer. For Moderna, the basic series is two doses, so the child needs to complete the first two shots with the original formula. The booster dose – the third dose – is the bivalent vaccine. For Pfizer, the primary series is three doses. The first two doses should have been the original formulation, but now the third vaccine is the bivalent vaccine.

CNN: What about young children who have completed three doses of the Pfizer vaccine — are they eligible for a fourth dose?

Wen: no. The FDA explicitly says that children ages 6 months to 4 years who completed their initial three-dose series with the original Pfizer vaccine are not eligible for a fourth dose of the bivalent vaccine. This is because the initial three-dose series of vaccine is still expected to have strong protection against severe disease of Omicron. This recommendation will be re-evaluated as new data emerge.

CNN: Can parents and caregivers who have not completed the initial series of Moderna opt for the bivalent vaccine as a second dose?

Wen: No, the FDA’s authorization for Moderna’s primary adult series — the two doses — is for the original monovalent vaccine. Likewise, there is no choice about which vaccine formulation to give as a booster for Pfizer in adults. The bivalent booster is only available as the third shot, not the original monovalent, which is still given as one or two doses. This reflects the permission given to adults – the initial series is the monovalent vaccine, with Pfizer and Moderna’s only adult booster being the updated booster.

CNN: What are the possible side effects of the updated booster?

Wen: It is expected that children who receive an updated booster dose will have similar types of side effects as the original vaccines. These side effects tend to be mild and short-lived, and usually go away in the first 24 hours after vaccination. Adverse reactions can include pain and swelling at the injection site, tiredness, crankiness, drowsiness, headache, muscle aches, and sometimes fever. Many children do not experience any side effects. The risk of serious side effects, such as myocarditis (inflammation of the heart muscle), is expected to be extremely rare in this younger age group.

CNN: What if children actually contract Covid-19?

Wen: People who have had Covid-19 can wait three months until after they have recovered from the coronavirus to receive another vaccine dose, according to the CDC. They are likely to have very good protection against infection in this period.

Numerous studies have shown that hybrid immunity — recovery from Covid-19 combined with vaccination — provides very strong protection, arguably more than vaccination and boosters alone. In my opinion, I think a case can be made that if a young child has received the initial series and already has Covid, they can wait to get another booster. This is especially true if they had Covid recently, in the last year. To my knowledge, there is no research showing an added benefit to boosters for young children who have recently had a Covid-19 infection and who have had their initial vaccinations.

CNN: Which families should consider the updated augmentation now and who should wait?

Wen: First, I think it’s important to note that uptake of the primary series of Covid-19 vaccines among young children is very low. According to the Centers for Disease Control and Prevention (CDC), less than 5% of children 5 years of age and younger are fully vaccinated. This means that we are referring to a very small group of children who are newly eligible for the upgraded boosts.

There is one group that I would definitely recommend getting the updated booster. This is the group of children who received their first one or two doses of the Pfizer vaccine. These children need to complete their basic series. The third dose of that series is now the updated bivalent booster. There is no reason for the families of these children to wait; They must complete the initial chain, and it is a bonus that the third potion will be updated to target Omicron.

For children who have had two doses of the Moderna vaccine, I think the decision-making is different and will depend on the families’ individual circumstances. Some families are very worried about contracting Covid-19. Perhaps their child has underlying medical conditions, or they live with someone who is elderly, immunocompromised, or otherwise has a high risk of serious outcomes from Covid-19. Perhaps the family will welcome a new baby soon, and that baby will be particularly vulnerable to contracting the coronavirus. I think it’s reasonable to decide that given the rise in Covid-19 cases, it’s time to get their updated booster little one.

I also think it’s reasonable to wait. My kids (ages 2 and 5) received Moderna vaccines over the summer. They qualify for the boost, but I’m holding back because the protection they have against severe illness is still strong. Boosters will provide additional protection against symptomatic infections, but this effect may be short-lived, according to a June study.

To be clear, I think it is critical that the elderly and frail individuals receive the updated booster. I also think it’s generally a good idea for people to opt for a booster if they want to, as there are compelling individual reasons for different families.

Parents and caregivers who have questions should consult with their pediatrician to determine the best course of action for their particular family circumstances. Finally, families whose children have not yet received any Covid-19 vaccinations should consider getting started, especially if their children are not known to have Covid-19.