Similar to their older peers, children ages 5 to 11 should get a third dose of Pfizer/BioNTech’s COVID-19 vaccine (Comirnaty), the CDC’s Advisory Committee on Immunization Practices (ACIP) said on Thursday.
In an 11-1 vote, with one abstention, the committee agreed that children ages 5 to 11 should receive an additional dose of the mRNA vaccine (which would be a total of four doses for immunocompromised children) at least 5 months after their primary series.
This harmonizes the recommendations for this age group with the rest of the population, as a booster dose is recommended for everyone ages 12 and up. (People 50 and older can get a second mRNA booster as well.)
In addition, many ACIP members seemed to openly acknowledge that data now indicate this is really a three-dose vaccine rather than two doses and a booster.
“I would hate to suggest that a third dose isn’t necessary if we’re thinking of these three doses as part of [the] full protection a person needs, regardless of age,” said Lynn Bahta, RN, of the Minnesota Department of Health.
Matthew Daley, MD, of Kaiser Permanente Colorado in Aurora, added that multidose vaccines, such as diphtheria, tetanus, and acellular pertussis (DTaP), are a part of early childhood routine immunization series, and that research in other populations showed that a booster dose of mRNA vaccine “provided measurable, detectable benefit across a wide range of health outcomes.”
“Why would we think the same would not be true for children when they receive a lower dose?” he added. “Would it make sense that 5- to 11-year-olds are the only group … where a third dose isn’t necessary?”
ACIP members also pointed to data presented by CDC staff, which not only showed that vaccinated children were less likely to be hospitalized, but may be less likely to develop long COVID symptoms.
“We tend to focus and define severe disease by hospitalization and death, [but] the impact and severity of long-haul COVID on kids is substantial,” said ACIP Chair Grace Lee, MD, of Stanford University in California.
The other alternative that the committee rejected was a permissive recommendation, a so-called “may” recommendation, which liaison representative Patsy Stinchfield, RN, of the National Association of Pediatric Nurse Practitioners, cautioned against. She warned that for many people, “may” equals “meh,” meaning the recommendation would not sound that important.
However, Helen Keipp Talbot, MD, of Vanderbilt University in Nashville, Tennessee, disagreed. She pointed to not only the fact that only 29% of children ages 5 to 11 have completed their primary series, but that 77% of them have serologic evidence of exposure to COVID. She thought the resources could be better spent vaccinating the 70% who have not been vaccinated yet.
“If it really takes three doses, but yet 77% have been exposed, could it not be their original exposure plus two doses that gives them immunity,” she said.
Talbot also pointed out that with talk of boosters being available in the fall, she would be uneasy about kids going into school in August and September not being eligible for a booster since they would have already gotten it back in June.
“It makes more sense for us to wait for the fall unless [the child is] immunocompromised,” she noted. “How sustainable is it for us to vaccinate the population every 6 months, I don’t think that’s going to work.”
Amanda Cohn, MD, of the CDC, added that while boosters may be available for adults in the fall, it is unclear whether they will be available for children, since it is a “different formulation” of vaccine.
As always, Sarah Long, MD, of Drexel University in Philadelphia, reiterated her position that this vaccine was not meant to prevent transmission. While she voted yes, she wanted a number of caveats added about time since they were exposed to COVID.
“It’s wishful thinking to think that three doses are the deal,” said Long. “The vaccines we have right now with the spike protein is a dumb response, in that you get a boost, but we have seen … booster immunogenicity fades.”
CDC currently recommends that all individuals who were infected with COVID wait 3 months prior to receiving a vaccine.
As always, recommendations of the ACIP are not considered final until they are published in the Morbidity and Mortality Weekly Report.
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