When reports of SARS CoV 2 infection-causing Covid-19 disease emerged from China, an impression was created that Sars CoV 2 did not include infected children. Soon this myth gave way to the understanding that children too were infected, but in most instances, it was mild and self-limiting, rarely requiring hospitalization. Soon it emerged that though Covid 19 disease was either asymptomatic or mild, children who became severely ill usually had one or more underlying conditions, including obesity, asthma, sickle cell disease, or immunosuppression.
A hyperinflammatory syndrome called multisystem inflammatory syndrome in children (MIS-C) presenting with fever and abdominal symptoms—mainly if they develop conjunctivitis or rash- requires a referral to a pediatric emergency department for evaluation. MIS-C could have overlapping symptomatology with disease processes that require prompt treatment, such as sepsis, toxic shock syndrome, myocarditis, and meningitis.
After having asymptomatic or mild covid -19, some children found that on return to the playing field or online classes, they had mental fog, headache, fatigue, or low energy, which are typical symptoms of long covid.
When vaccines became available for use due to the limited quantity, children were depriotized. However, it was clear by then that children could become infected and transmit infection within the household to elderly and more susceptible grandparents with multiple comorbidities. Of course, initial clinical trials did not include children as subjects, so the initial EUA had 18 years and above as the permitted age group.
When vaccines became available for use due to the limited quantity, children were depriotized. However, it was clear by then that children could become infected and transmit infection within the household to elderly and more susceptible grandparents with multiple comorbidities. Of course, initial clinical trials did not include children as subjects, so the initial EUA had 18 years and above as the permitted age group.
Now nearly one year after the approval of the first generation of vaccines, vaccines that have been approved in India for use in adults, they are 1. Oxford University Astra Zeneca vaccine manufactured by Serum Institute of India : covishield; 2. Bharat Biotech Covaxin; 3. Zydus Cadila’s Zico V -D; 4. SII Covavax (Novovax formulation) ; 5. Biological E’s Becov 2 A , 6. J & J Ad 26 CoV.23; 7. Moderna m RNA-1273 and 8. Gamaleya Sputnik V. While in USA 1. Pfizer; 2. Moderna and 3. J & J’s vaccines have been approved for use in children. In India, even though 5 vaccines have been approved for use in Children In India, at present, only Covaxin has been approved for use in children by CSCDO for use in children between 12 and 18 years, and the initial focus has been to inoculate children between 15 and 18 years of age. In the meantime, covaxin phase 2/3 clinical trial efficacy and safety data on children between 2 and 18 is available in the public domain. Another study carried out in the USA by Emory University and reported by Ocugen has shown that covaxin vaccinated persons produced neutralizing antibodies, which could neutralize delta variant and omicron variant, which at present is responsible for the third wave in India.
Since the infection is primarily mild or asymptomatic in children, only a highly safe vaccine with no severe side effects must be chosen as it would be used for most healthy children. The vaccines available in the USA, Pfizer, and Moderna use m RNA technology which is being used successfully for the first time in humans and has never been used on children in the past. Initial fears of anaphylaxis reactions have given way to the occasional thrombosis in women but have not thrown up any severe side effects when used in the USA. In addition, the non-replicating adenovirus vector-based vaccine used by Oxford University Astra Zeneca covishied, Johnson and Johnson or Sputnik has been used for ebola in Africa in thousands of cases, and again, except for those in Africa for the occasional thrombosis, there is no severe side effect.
However, Covaxin appears to be the most suitable vaccine for use in children. In a study involving a total of 526 children and using two doses of 0.5 ml Covaxin (the same dose as in the adults) given 28 days apart, excellent results were obtained. The children were divided into three groups: group 1 (age 12 to 28, n=176), group 2 (age 6 to 12, n=175) and group C (age 2 to 6, n=175). No serious adverse effect, death, or withdrawal was reported. The vaccine was well tolerated. There was no substantial difference in reactogenicity profile between different age groups in the three groups. A similar immune response too was observed in all the children studied, with microneutralizing antibodies being generated at a better titer than in adults. In all age groups, seroconversion (measured by PRNT was 95 to 98%). Vaccine response was skewed towards Th1 response with IgG1/IgG4 ratio above 1.
Ocugen, a CRO in the USA, reported results from a study conducted at Emory University demonstrating sera from subjects who received a booster dose of candidate vaccine Covaxin BBV152 six months after getting a primary two-dose series of Covaxin neutralized the SARS-CoV-2 Omicron and Delta variants.
The company said that earlier studies demonstrated the neutralizing potential of Covaxin against SARS-CoV-2 variants of concern Alpha, Beta, Delta, Zeta, and Kappa.
Ocwen said sera samples from individuals who received a booster of Covaxin were observed to be effective in neutralizing Omicron and Delta variants on a live virus neutralization assay. The neutralization activity of Covaxin-boosted sera was comparable to what has been observed in mRNA vaccine-boosted sera against the Omicron variant, it said. More than 90% of all individuals boosted with Covaxin showed neutralizing antibodies. They have applied for EUA to USA FDA.
The vaccine has been shown to decrease the transmission of the virus, so parents would be well advised to vaccinate the children as permitted by the Government of India. We would urge all school-going children to be vaccinated as covaxin become available and authorized for them. Schools can safely open only after most of the children have been vaccinated.
In the meantime, all of us need to follow appropriate covid-19 behavior.