Worried about myocarditis? ‘Choose vaccination,’ says pediatric specialist

The authorization of a pediatric COVID-19 vaccine for children aged 5 to 11 made many parents want to make appointments as soon as possible in early November.

In Yolo County, about one in four children in that age group received their first dose since the vaccine was approved a month ago, and about 8 percent are now fully vaccinated, according to county data.

But as a result, 75 percent of 5 to 11-year-olds in the county are still without protection against the virus, prompting UC Davis pediatricians Thursday to consider why children should get the vaccine as soon as possible.

During a zoom forum hosted by Healthy Davis Together, Dr. Dean Blumberg, chief of pediatric infectious diseases at UC Davis Children’s Hospital, commented that “a lot of people have concluded that children are not at risk for COVID. And that’s just not true.”

“As a pediatric disease specialist,” he said, “I see the pediatric patients who are hospitalized in the ICU for COVID, for complications.”

Nationwide, he said, 1.9 million children ages 5 to 11 have been infected with COVID and more than 8,000 have been hospitalized.

About a third of those hospitalized ended up in intensive care and more than 2,000 ended up with childhood multisystem inflammatory syndrome (MIS-C).

“Those kids are scary sick,” Blumberg said, “and that’s most common in this age group, the 5 to 11 year olds.”

There are also 94 deaths in this age group from COVID, he added, “meaning it equals the eighth leading cause of death in the past year.

“So for individual children in this age group, the 5 to 11 year olds, it’s very important to get them vaccinated…there is no doubt that the benefits of vaccination far outweigh the risks of vaccination.”

One of the risks for many parents is myocarditis, an inflammation of the heart muscle and an extremely rare side effect associated with COVID vaccination.

Blumberg said it is likely that the cases of myocarditis after vaccination are related to the spike protein in the virus, as the heart condition is relatively common in individuals infected with COVID-19.

“That’s the similarity between the vaccine and COVID itself,” he explained. “It’s the spike protein. So there’s something about the spike protein that’s somehow causing that inflammation.”

Blumberg said he has seen several patients with myocarditis after vaccination.

“They generally have chest pain, shortness of breath, and this responds very well to anti-inflammatory drugs and sometimes stronger anti-inflammatory drugs given intravenously,” Blumberg said.

“If someone gets myocarditis after being vaccinated,” he added, “the prognosis is excellent. They usually spend a day or two in the hospital. Heart function is usually unaffected. If it’s affected, it’s mild and over-reacting.” generally on treatment.”

However, he said: “If someone has myocarditis after a COVID infection, which occurs at a greater rate compared to after vaccination … it is usually more severe.

“Those children stay in the hospital longer and end up needing more treatment and that can have long-term consequences.”

Myocarditis is 100 times more common with COVID infection than vaccination, Blumberg said, and is more than 1,000 times more common with multisystem inflammatory syndrome in children compared to vaccination.

“So any parent concerned about myocarditis in their child is opting for vaccination,” he said. “That’s the best way to protect them from getting myocarditis.”

Of those who developed myocarditis after vaccination, the highest rate occurred in young men ages 12 to 29, Blumberg said, and no cases of myocarditis were reported in the clinical trials for children ages 5 to 11.

As for all the other possible side effects of the COVID-19 vaccine, those would have surfaced by now, he said.

“In the history of vaccination, the longest-lasting side effect ever seen occurred five weeks after immunization and that was with the smallpox vaccine, a vaccine that had many side effects, so it is no longer routinely used in the general public,” said Blumberg. “And that vaccine did cause inflammation of the heart five weeks after vaccination.”

With the COVID vaccine: “I am confident that we have not seen any long-term side effects, it has been more than five weeks, we have a lot of experience with these vaccines – more than 7.8 billion doses administered worldwide and more than 460 million doses administered in the US – so I’m confident we won’t see any long-term side effects.”

But there are long-term side effects for some children infected with COVID-19, Blumberg said.

“Long covid occurs in children,” he said.

“Children sometimes experience prolonged symptoms including fatigue, fever, unable to perform their normal functions. They have blurred thinking, headaches and things like that. It appears to be less common in vaccinated children compared to unvaccinated individuals.”

With those breakthrough infections, Blumberg said, covid is about half as common as those who were unvaccinated and infected.

“It also seems to be less common in children than in adults, but we are still learning a lot about long-term COVID,” he said. “We need more information about that. Especially how long it often takes.”

The short-term side effects of vaccination in children ages 5 to 11 are similar to those seen in teens and adults, Blumberg said. Namely, pain and swelling at the injection site, fever, fatigue and headache, “and they are less common in children ages 5 to 11 compared to the older children, 12 to 17 year olds and adults,” Blumberg said.

“Most of these side effects last a day or two. If they are severe, such as if your child has such a bad headache that they have to lie in bed and they just can’t function, they generally respond very well to anti-inflammatory drugs like ibuprofen… a day or two.”

Looking ahead, Blumberg said he expects a vaccine for children under 5 to be approved sometime in the first quarter of 2022.

As for what everyone is talking about – the Omicron variant – Blumberg was optimistic.

“This variant is worrisome,” he said, “and the reason it’s worrisome is that it has more than 50 mutations compared to the original strain, and more than 30 of those mutations are on the spike protein.

“And we know from experience with these mutations in other strains that some of these specific mutations are associated with increased transmissibility, some of them are associated with the virus being more contagious, and some of those mutations are associated with avoidance of neutralizing agents. antibodies from either vaccination or previous infection.

“So what we don’t know is how transferable it is. We have predictions that it will be more transferable, but I can’t give you a number. We knew that the Delta variant was about 90 percent more transmissible compared to the original strain, but we don’t know that for Omicron. We don’t know how much the immunity is compromised in terms of previous vaccination or infection, while we do know for Delta. We know that vaccination gave about 5 to 10 percent less protection against Delta compared to previous strains. So not that much different; vaccination was still very beneficial. But we don’t have any numbers to associate that with Omicron.

“We now have more questions than answers,” Blumberg said. “All I can say about it is that it’s worrying and we need those answers because it could be bad, or it might not. We just don’t know.”

That said, Blumberg added that he is confident there will be at least partial protection with current vaccines.

“And when you get the booster shot, the antibody response is extraordinarily strong, extraordinarily high, so I’m convinced there will be some protection if you…. boosters.”

As for updating current vaccines to target Omicron, Blumberg said, it will be a few months before they become available.

“I’m sure they’ve already made the vaccines,” he said. “This mRNA technology is so fantastic that you can just swap the gene for the spike protein from one strain to another, so I bet they did that earlier in the week.

“But then they have to make the vaccine, and then you want to test it to make sure it’s safe and effective. So for that you want to get 100,000 people vaccinated, wait a few weeks after they’re vaccinated, draw their blood, get a good immune response, analyze the data … that’s going to take a few months to do that.”

Blumberg noted that there’s kind of “gloom and doom” with the rise of Omicron, but the truth is that “we’re in a much better place than we were a year ago.

“We have an abundant vaccine available. We know the vaccines work. We know they are safe, they are effective. We have abundant diagnostic tests. We have treatment for people who have been hospitalized. We have monoclonal antibodies available for those 12 years and older… if they are at risk of progressing to a more serious disease. We have antiviral pills that will be available soon for outpatients.

“So we’re in a much better place now than we were a year ago,” he explained. “So even if the Omicron variant turns out to be very dangerous, I’m very confident we can deal with it and I’m confident we’ll find ourselves in a post-pandemic world very soon.”

— Reach Anne Ternus-Bellamy at aternus@davisenterprise.net. Follow her on Twitter at @ATernusBellamy.

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