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There are still no COVID-19 vaccines approved for children. As more adults get vaccinated, what should families with kids do?

The degree to which vaccination prevents transmission of COVID-19 is still being studied, which means parents still need to exercise caution.

Pfizer vaccine
The Pfizer vaccine is approved for people as young as 16, and Moderna and Johnson & Johnson are for those 18 and older. Why isn’t there one for younger kids?
REUTERS/Lucy Nicholson

This week, as Minnesota expanded COVID-19 vaccine eligibility to everyone over at 16, parents with younger kids find themselves in a predicament: suddenly a vaccination is in sight — for them. But with no vaccine yet approved for those under age 16, it’s likely to be a while before their whole family has the protective immunities conferred by COVID-19 vaccines.

That makes the prospect of going out to eat, going on vacation or spending time with other families a little more complex. We talked to experts about what families with kids under 16 need to know.

The Pfizer vaccine is approved for people as young as 16, and Moderna and Johnson & Johnson are for those 18 and older. Why isn’t there one for younger kids?

We’re just not there yet. Both Moderna and Pfizer are actively doing clinical trials on kids as young as 6 months old. J&J is also planning trials in younger people.

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So far, the results of trials in younger people are encouraging. Data aren’t formalized yet, but on Wednesday, Pfizer announced preliminary data from its trials in 12-to-15-year olds found the vaccine appears to work extremely well in that age group, with no serious side effects.

Most trials go down to kids as young as 6 months because in many cases, kids don’t tend to develop strong antibodies from vaccines when they’re younger, said Dr. Frank Rhame, Allina Health infectious disease specialist. That’s why most vaccinations, except pertussis, start at 6 months. Plus, if their moms are vaccinated, very young babies should get protective antibodies in the womb and/or from breast milk.

Because trials are still ongoing, experts are saying it’ll be months, and the availability timeline is likely to vary based on age, with older kids possibly eligible as early as fall and younger kids in early 2022.

Why is this taking so long?

All this vaccine stuff is actually happening remarkably fast, it just might not feel like it right now as we hurry up and wait. But one reason it’s not happening faster is because the bodies that make recommendations for vaccines are really careful about them, Rhame said.

“People seem to be more reluctant to take a vaccine, so in the vaccine world, they don’t ever make a recommendation without really really solid data in hand, and that takes time, so they’re probably not going to recommend it until they get a done trial,” he said.

There is some possibility that a COVID-19 vaccine could be recommended for kids in accelerated fashion based on what’s called a bridge study, said Dr. Mark Schleiss, a professor of pediatrics and a vaccine researcher at the University of Minnesota.

If you have an idea of what a kid’s immune response needs to be for the vaccine to work, this can be a shortcut.

“If you prove that it’s safe, prove that it induces an immune response that’s protective, you may not need the third piece of the puzzle, to prove it reduces transmission and prevents disease,” he said.

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Is the vaccine likely to be safe in kids?

Yes.

“I don’t anticipate that there will be any problems,” Scheiss said. “There’s no biomedical basis to believe that any of the vaccines that we currently have licensed in the U.S. are risky in any way.”

There are short-term side effects — fever, headache, sore arms, fatigue — but those go away quickly, and may present less frequently in children.

Is there a way to somehow get my kid vaccinated before then?

Potentially. Schleiss encouraged parents to enroll their children in clinical trials for the vaccines. Trials recruiting participants can be found on clinicaltrials.gov, and there’s a filter for trials recruiting children.

What does a likely monthslong wait for a vaccine mean for school in the fall?

Given where trials are at, it’s likely safety measures will have to remain for a while — certainly into the fall when the 2021-22 school year starts.

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“That includes masking children over the age of 2, that includes strategically designing their school day in such a way to minimize large group assemblies, having small, focused groups of children, distance of at least three feet, downsized from 6 feet,” Schleiss said. That also means investing in infrastructure for schools, including ventilation, shields and cleaning supplies.

Do kids really need to take precautions in the meantime? They’re less likely to get sick or die of COVID-19.

It’s true kids are less likely than older adults to get very sick or die from COVID-19: 3 percent of people who have been in the ICU with COVID-19 in Minnesota are 19 and under, and there have been just two deaths in anyone under 20.

“The younger they are the less likely they are to be symptomatic, and the rate of hospitalizations is very low in young children, but it’s not zero,” said Dr. Elyse Kharbanda, senior investigator at HealthPartners Institute who studies vaccines. Furthermore, kids may be unlikely to get sick, but they are more likely to have asymptomatic infections, which means they can spread COVID-19 to others without it being obvious.

Vaccine coverage is more than 80 percent for Minnesotans 65 and older, but many adults in other age groups are still waiting to get the vaccine. Kids, particularly older children and adolescents can be conduits for transmitting the virus to people who aren’t fully protected.

“If people were to become more lax, we’d have less testing and we’d be less likely to pick up these asymptomatic infections,” she said. Currently, the best tools we have are symptom monitoring and frequent testing to find asymptomatic infections, and those are really important.

Is it okay to take my kid out to a restaurant before they’re vaccinated?

It’s probably fine if you’re careful.

“I think you can go out to eat if you’re disciplined about the way you do it,” Rhame said.

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Soon, it’ll be easier to eat outdoors, and that’s the safest. But if a restaurant is adhering to distancing and masking guidelines, and if a kid isn’t around vulnerable people, plus the adults are vaccinated, “your risks are considerably diminished,” he said.

“What you really don’t want to do is have the kids visiting granny and grandpop who for some reason refused the vaccine,” Rhame said.

If I, fully vaccinated, go out to a bar with my fully vaccinated friends, is it likely I’ll bring COVID home to my kid?

We don’t know yet. Studies have found the vaccines prevent severe illness and death, and data on the Pfizer vaccine out of Israel suggest it also prevents people who are vaccinated from transmitting the virus, but it’s early to know to what extent, exactly, that’s the case. This week, officials who made bullish statements on the vaccine’s ability to prevent transmission have had to walk them back because we don’t have enough data to know for sure yet.

That’s one of the reasons (but not the only one) people still need to be careful. Once we know more about whether vaccinated people can transmit the virus even if they don’t get sick (which we should soon), we’ll have a better sense of how safe activities like this are.

What about spending time with their friends or other families with young, also unvaccinated kids?

Again, care is key, Rhame said. Keeping groups small is a good idea.

“My daughters who have small kids have developed a couple of friends who they like and their kids like and they try to do their playdates with a small number of people who also try to restrict the number of people that they see,” Rhame said. “So again, discipline allows you to do a lot of stuff safely enough to do it.”

Any other advice for parents?

Kharbanda’s advice for the adults in kids’ lives, including parents, coaches and teachers, is to be good role model.

“A lot of their behaviors regarding wearing masks and social distancing is really modeled on the behaviors that they see and the messages they’re getting from the people around them,” she said.