In the latest installment of our occasional conversations with Fort Worth leaders, Dr. Patricia Rodriguez, a pediatrician and chief medical officer of North Texas Area Community Health Centers, explains the difference between the adult dose and the child dose of the COVID-19 and addresses common misconceptions about both.
This conversation has been edited for length and clarity.
Alexis Allison: We know that the FDA recently authorized for emergency use the Pfizer vaccine for children ages 5-11 and that those vaccines are now available in Tarrant County. Dr. Rodriguez, can you explain the differences between the child vaccine and the adult vaccine?
Patricia Rodriguez: Sure. The main difference is that for the children ages 5 to 11, the dose is one-third of what it is for adults. So it is a smaller dose, and it is still a dose that can induce the immune system reaction that we’re looking for.
Allison: And say a family were to come to you and want to know the possible benefits and consequences of getting a child vaccinated. What would you tell them?
Rodriguez: Yeah, so we talk about the risks and the benefits with families with any vaccine that we give, actually. This is not just with COVID. We talk through routine pediatric vaccines as well as flu vaccines, risks and benefits all the time. In particular for this vaccine, I say that the risk is that, because we are tricking the immune system with a vaccine, there’s always a natural reaction that can occur with any vaccination. For this one in particular, you can get fever with this vaccine that can be off and on for usually a couple of days. You can get soreness at the site of injection. You can feel achy. You can feel kind of like you’re not quite like yourself. But usually those side effects are mild and can be treated with over-the-counter Tylenol or ibuprofen until they subside, and they usually last no more than 48 hours. On day three post-vaccination, you literally are back to your normal self.
Allison: It sounds like children may have similar side effects from the vaccine as adults. Are there any more long-term consequences or worries that you’ve heard families have that you’d like to address?
Rodriguez: I think that one of the things that’s important to address is that the vaccine does not affect your DNA. The vaccine does not have an ability to change your genetics in any way, shape or form. It is something that is like any other vaccine: It literally is a way to trick your immune system into producing antibodies that will be protective should you be exposed to the COVID virus. Other than that, there really are no other side effects long term, at least that we know of yet. What we do know is that the vaccines have been in use for adults, even beginning as early as the summer of 2020, when it began in trial phases, and then open to eligible people in December — at least in the U.S., it was in December — of 2020. So we’re literally coming up on a year and plus some months of using this vaccine, and billions of people have received this vaccine at this point and are continuing to be monitored, and thus far there are no long-term effects that are known. The other thing to say is that, sometimes I hear from parents that the vaccine was rushed, and how can we trust something that was rushed? Well, I want to point out that speed is not the same as ’rushed.’ The technology for mRNA vaccines — (the Pfizer vaccine) in particular is an mRNA vaccine — the technology has been in existence for at least a decade. It has been used in trialing other vaccines for diseases like respiratory syncytial virus, RSV, which causes a lot of wheezing episodes and problems breathing in kids that are especially the young ones. It’s been trialed for a possible HIV vaccine. It’s been trialed for other Coxsackie viruses and other things like that. So it’s like the mold already existed, we just plugged in the different puzzle pieces that make it unique to the COVID virus. So, it’s not new, per se. It’s been around for a long time and studied for a long time.
Allison: Thank you for sharing that context and history. I’m wondering if a family decides, ’OK, we’re going to get our children vaccinated,’ how do they go about doing so? And what do they need in order to get that vaccine?
Rodriguez: So at this point, the vaccines are much more readily abundant and easier to access than they were even a year ago or even nine months ago. So at this point, I would advise patients to call their local pediatrician and ask whether or not they’re carrying the vaccine. If they don’t, then they can reach the Tarrant County Public Health Department to ask for different sites that may be stocking those vaccines. I know that at one point, the CDC had a list of the clinics that were administering COVID-19 vaccines. Because now the vaccines are much more abundant, I don’t know if those lists are still up to date, but that’s one place to look as well. But I think always start with your pediatrician. You can also ask your local pharmacist, your CVS, your Walgreens, your Kroger’s, your Walmart pharmacies. All of those places also, if they don’t carry it, should know where to refer you. And of course, your local community health center in Tarrant County, which is North Texas Area Community Health Centers. We do have the vaccine that is in stock and we are just waiting to get all of the details worked out so that we’re able to administer the vaccine and document it in the medical record. So we are literally days away from being able to do that.
Allison: That’s great. And I’m glad you brought up the county health department. I know that they have a website where people can search for vaccination clinics near them, and that’s www.tarrantcounty.com/vaccinefinder. One question I have regarding the difference in the doses between the child dose and the adult dose: Say you have a child who’s 11, and they would be eligible for the child size dose. Should they wait until they’re 12 to get the adult dose? How would you advise families on that question?
Rodriguez: So the way that I would advise people is to say, this is no different than any medication that’s over the counter. Age 12 is when we begin adult dosing, and that’s consistent with what you see even for ibuprofen or Tylenol or Benadryl or whatever the case may be. So it has not to do with age necessarily, it has more to do with the maturity of the immune system and how you decide who gets what dose. I’d say that, if they’re very, very close to the 12 year mark and your child is at a low risk of severe effects from the COVID virus, and if you wanted to wait a month or so, that’s probably fine. But if they’re not anywhere near their 12th birthday, there’s not a reason to wait.
Allison: I’m wondering if you know, in terms of a timetable, when do you think children under 5 would be eligible for the vaccine?
Rodriguez: It’s hard to tell. The rollout of the ages 5 to 11 had been discussed even as early as the springtime of 2021. And here we are in November and just now starting to do this. So there are a lot of different layers of safety and monitoring and things of that nature that have to be done before we get approval for something like this. So I think we’re getting close. I’m not quite sure, though, if I can really say solidly how far away we are.
Allison: Thank you. And is there anything else that you think we should know about this child’s vaccine?
Rodriguez: Yes, I do. One other thing I really wanted to point out is that kids aren’t spared from the harm of COVID-19. I think there is a misconception that children do not die from COVID-19, or they don’t suffer hospitalizations or even long-term COVID or other sequelae from COVID. And I want to point out that more than 1.9 million kids have been infected with COVID-19 to date. Around 8,300 have been hospitalized and 94 kids have died. So it’s still making it the No. 8 killer for 5 to 11-year-olds. Kids are missing school. They are driving the transmission through the community now, because they are the ones that are most likely to get infected at this point. They are also suffering from long COVID-19, which are COVID symptoms that persist beyond the acute illness period. So it’s really important for parents to understand that, while it is true that kids don’t die from COVID-19 illness at the rate of adults, they still can suffer from this disease. They still can have long COVID 19. They can also infect others. And so it is important to vaccinate the 5 to 11-year-olds.
I also wanted to point out that if they have underlying health conditions, 32% of the kids that had pediatric hospitalizations due to COVID-19 did not have underlying health conditions. So even healthy children do wind up in the hospital. So it’s not just for those with a weakened immune system or other problems — it can also affect healthy kids. About 38% of kids ages 5 to 11 have detectable antibodies from natural infection. There’s also this thought that, well, they’ve already had it so I really don’t need to vaccinate my child. Natural immunity protection is a little bit more random and not as strong as you get from the vaccination, and there’s no way to predict how well your child’s antibodies are going to protect him or her down the line. Right. So, the risk of reinfection after a natural COVID infection is 2-5 times higher than the risk of reinfection with vaccines. So it’s still really important to remember that.
And natural immunity is protective at first. For some people, it’s looking like it can last at least eight months — we don’t know if it’ll last longer. But for some, the protection wanes within weeks, and we don’t really know where your child will land in that spectrum. So vaccination is the best way to really mount a solid immune system response. It is a lot more targeted and less random than your own body’s natural immunity in the way that it responds to the virus itself.
So those are just a couple of extra things I wanted to point out that I think are important to remember, because there are so many conversations that are had, I think, between families on social media that sometimes are truly misguided. And I think people do
believe a lot of what is said. But unfortunately, a lot of what is said is not passed down with scientific information. It is anecdotal, it’s personal. It’s driven by sentiment rather than actual facts. So I do definitely tell parents to do their own research but to really do it with resources that are reliable. So, for example, you can go to the CDC website to look at information for COVID-19, the American Academy of Pediatrics — the AAP — in particular, healthychildren.org, which is part of the AAP, but a great resource to parents and also has a lot of great information. So those are just some extra tidbits again that I wanted to share.
Alexis Allison is the health reporter at the Fort Worth Report. Her position is supported by a grant from Texas Health Resources. Contact her by email or via Twitter. At the Fort Worth Report, news decisions are made independently of our board members and financial supporters. Read more about our editorial independence policy here.