Dr. Corey A. Fish (He/Him)
31 Mar 2021Dr. Corey A. Fish (He/Him)

VIDEO: The COVID Vaccine for Kids, a Q&A with Dr. Fish

VIDEO: The COVID Vaccine for Kids, a Q&A with Dr. Fish

Now that many adults and older teens have access to the COVID-19 vaccines, parents are wondering when kids gan get their shot. Brave Care CMO and pediatrician, Dr. Corey Fish, was LIVE on Facebook answering questions about the development of vaccines for kids; vaccination info for pregnant and breastfeeding parents and looking a head to the safety of summer travel.

Watch the video below or read the Q&A transcript.

Q: Why can’t my children just get the adult version of the vaccine?

A: The assumption is that “a smaller person needs a smaller dose” or less medication and that's actually not always the case. If you think about some of the vaccines we already have like diphtheria or tetanus, kids actually need a higher dose of some of the components in those. As adults, our immune systems are well-developed—we get exposed to something and we rapidly mount our immune response. Our bodies go to work getting rid of it. Kids’ bodies need more education and more training so that they can mount that immune response. 

The same way a lot of you parents may have to remind your two-year-old that the garbage can is not a play space—and you probably have to do that multiple times—is the same idea for the body's immune system. More reminders and education!

Q: When will my 5 year old be able to get a vaccine? When will the trials be completed?

A: Trials for a couple of the major vaccine manufacturers for 12 years old and up have been fully enrolled and that's being tested right now. It’s been said that the 12 and up group could be eligible for vaccines as soon as later this summer or fall, but the hard part about the development process is that we need that data from the 12+ group before we can start thinking about the younger ones. 

It’s hard to say, but I think ultimately those trials are going to have to be completed before the trials for the 5 year old groups can start, so I suspect it won't be until 2022 that there is a vaccine approved for the little ones. 

Q: Apparently grandparents can hug grandchildren now! If grandparents are completely vaccinated, do the grandparents and grandkids have to wear masks? Are kisses okay?

A: The CDC came out with guidelines for the two vaccines that are in wide circulation right now—you’re considered immune two weeks after both the Pfizer and Moderna vaccine. That means you can hug, you can share drinks, etc. The next set of guidance says that people who are vaccinated may hang out and interact in a normal way with people from a single household who have not been vaccinated. So in the case of grandparents and grandkids you know technically the guidance is that if you have one set of grandkids from a single household, that's fine, but if you have grandkids in multiple sets of households, the guidance would be that that's not OK yet. 

We keep tabs on the CDC’s guidance and regularly update our FAQ on our website

Q: Is the next age group 5-11 years old?

A: Yes, that’s likely the age range. 

Q: Is it safe to breastfeed after I’ve been vaccinated?

A: It’s a great question. There’s no guidance right now, and no indication to suggest that breastfeeding after you've had the vaccine  is dangerous in any way. In fact, we think it‘s likely somewhat beneficial, as you do get some antibody transfer from that breastfeeding process. 

I’d expect that actually having the vaccine could even be beneficial. The vaccine is rNA based, so it uses the genetic material of the virus, and your body then uses that genetic material as a blueprint to make sure proteins from the virus. Your body manufactures that protein and is subsequently recognized as foreign, so your immune system attacks it to get rid of it and mounts an immune response. 

My opinion, knowing that breast milk is the single best thing for kiddos whenever it’s possible, would be to say yes, continue breastfeeding after your vaccination.

Q: Why should we open schools when kids can't get vaccinated for another 6 to 12 months?

A: That’s a great question. I’ll preface this with the fact that my mom had a career in education, and my sister’s an educator—so people in education are very near and dear to my heart. 

It’s sort of a calculated risk. We known all along that the younger kiddos, particularly that 5 to 11 age group, don't get coronavirus as often. They don't spread it as readily, and large the trials for starting back in school have been fairly successful on the whole. So if we can get the older kids vaccinated and teachers I think that will substantially mitigate the risk of coronavirus transmission in schools.

It’s a highly personal decision, but we know there is substantial harm being done to kids the longer they are out of school, so I think that getting kids back in school safely is a noble and worthwhile pursuit.

Q: Should immunocompromised children stay out of school even though schools are  in the opening up to in-person instruction?

A: That’s a tough question. I think a lot of it depends on the nature of what the immune condition is. There’s a spectrum, and I think it's always worth bringing the child's health care provider into the discussion. If we can vaccinate all of the teachers, and all of the older kids, there will be a highly substantial risk reduction. 

Q: Knowing that very small children won’t be vaccinated soon, how safe is it to return to back to daycare?

A: The same logic largely applies—we know that trials of little ones being back in daycare or preschool at baseline, have been reasonably successful. Layering on vaccinations for the teachers that are involved really helps that. It’s a balance. We know the kiddos need socialization and they need to be back, and there's a whole range of emotional repercussions and developmental repercussions when that doesn't happen for long periods of time—it’s a pickle. 

If I had a preschooler, and I knew that the teachers and staff at that school or facility were completely vaccinated, I would feel fine sending my child. Again that's a personal decision for me to make, I'm not saying that you know everybody should fall in line, but that's me putting myself in a position based on what I know.

Q: If all of the adults in a three-family pod are vaccinated, what level of risk would there be for a newborn to be outside of them, hiking and just being outside. 

A: Again acknowledging that there's no total risk elimination as of yet, that that’s about as safe of a situation as I can conceive of. I would want to make sure that when the parents are around other people who aren’t vaccinated, that they’re still taking precautions.

Q: I’m seeing that daycares and preschools won’t disclose the percentages of staff that have been vaccinated. This makes it so hard to decide if it’s safe to return—I guess we just have to hope the majority have chosen to get vaccinated?

A: Yes, that’s definitely a pickle. It’s technically a HIPAA violation for the school to disclose that information. 

Q: Will it be safe for my child to get vaccinated?

A: I realize there’s a lot of concern around vaccines in general. Knowing what I know, and doing the research that I’ve done, I fully endorse and support every vaccine that we recommend for kids. I believe 100 percent that they’re safe, and I believe that the coronavirus vaccine is 100 percent safe. I know a lot of people are worried that the drug was rolled out too quickly, but it’s important to remember that the original SARS epidemic that hit us allowed us to have a baseline of research done. Not to mention the fact that viral vaccines aren’t new. The speed is just reflective of the fact of mobilizing a global community of scientists around a shared common goal—this is the amazing thing that we can come up with. 

Q: If a breastfeeding mom gets the vaccine, what about pumping milk and giving that to an older child? Will that be beneficial as well?

A: I don’t think that it would be beneficial. The breastmilk that potentially contains antibodies wouldn’t necessarily help because you don’t know how much you’d have to give the older child in order to impact the child in a meaningful way.

Q: Can we plan travel for this Summer or for next Winter?

A: I’m sure most of you have had to cancel trips and vacations to see loved ones. We’re right there with you. It’s been a huge bummer—we can’t wait to travel and see folks! I think the trend so far is really good in terms of vaccines and number of daily cases. The very best thing we can do is to continue to vaccinate folks. We’re unlikely to be at that herd immunity point until 80-90 percent of people have had the vaccine. We won’t be there by the summer, but certainly expect that June, July, August, will be better now. Maybe make sure travel insurance is there and you have a backup plan. I would be shocked if we get to next winter and there’s still substantial travel restrictions in place.

Q: Is sharing an outdoor dining table outdoors considered socially distanced?

A: It is if you can maintain that six feet distance. 

Q: I’m a teacher in a preschool environment that’s in-person. How important is it to continue disinfecting every single piece of material?

A: That’s a great question. If it were me, I’d say as long as all of the adults in the preschool are vaccinated, it’s probably ok to reduce the super intensive cleaning to just high touch-points for kids. Going back to standard hand-washing and standard cleaning you would ordinarily practice should be OK.

Q: What is the effect on children’s immune systems if there’s continued use of disinfectants in children’s environments?

A: That’s a great question, although not a new one. That question has been raised in a lot of different areas in medicine. There is a “clean hypothesis.” It’s a hard thing to study so it’s never been definitively demonstrated, but there is a belief that there’s more food allergies, more eczema cases, etc is because there’s more cleaning and sanitizing. I don’t have enough information to make a strong opinion on it. There’s definitely a balance between cleaning enough and not too much. My hope would be that as the adults in school settings are vaccinated, that we can take steps back to normal cleaning standards. It’s worth considering and keeping in mind. The benefits of cleaning for COVID outweigh the potential risks right now.

Q: As more vaccines come to market, what are your thoughts concerning one over the other?

A: This is a great question. People perceive one vaccine as being “better” than another. The important thing to keep in mind is the difference between the efficiency on paper and the “real world” effect. A 50-60% effective vaccine would have been phenomenal—the best the flu vaccine does in any given year is 40-50%. I think the same logic applies.

The best vaccine is the one you can get. I feel great about all three of them, Pfizer, Moderna and Johnson and Johnson. Get shots in arms, let’s just get shots in arms. 

Q: What are your thoughts on air travel for infants this summer?

A: There was a study on coronavirus vaccine transmission in airplanes, and it was found that it’s reasonably safe mostly in part to the high filtration rate in airplane air. I would say there’s probably not likely to be a huge difference traveling with an infant on a plane as there would be any other time. It’s always a good idea to make sure babies have at least one round of vaccines before they travel on a plane. Also knowing that nothing is ever zero percent, it’s relatively safe to do—especially if you keep a blanket over the carrier, making folks aren’t touching the kiddo, etc.

Q: When will vaccines be available for kids?

A: It’s an ever-evolving thing. I suspect 12+ will be available sometime this Summer to Fall. Younger kids, probably not until 2022.

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