Teens should get the COVID-19 vaccine, a UCI Health pediatric infectious disease expert tells parents

May 17, 2021
Dr. Coleen Cunningham is chair of the UCI School of Medicine's Department of pediatrics and senior vice president for CHOC Children's Hospital of Orange County.
Once children are vaccinated, "they will soon be able to fully engage in life again," said pediatric infectious disease expert Coleen Cunningham, MD, chair of the UCI School of Medicine's Department of Pediatrics.

With a COVID-19 vaccine now approved for children ages 12 to 15, parents should get their kids vaccinated, said UCI Health pediatric infectious disease expert Coleen Cunningham, MD.

“As a pediatrician and a parent, I strongly encourage all parents who have children age 12 and older to get them immunized,” said Cunningham, chair of the Department of Pediatrics at the UCI School of Medicine and a national expert on infectious diseases in children.

This will not only protect them and others from the virus, it will also help them return faster to normal activities, she added. 

Access for 17 million children

The Pfizer-BioNTech vaccine is available to these children after approvals by the U.S. Food and Drug Administration (FDA) and the U.S. Centers for Disease Control and Prevention (CDC).

“This action opens vaccination to approximately 17 million adolescents in the United States and strengthens our nation’s efforts to protect even more people from the effects of COVID-19,” CDC Director Rochelle Walensky, MD, said in a statement.

Walensky’s May 12 statement followed the FDA’s May 10 authorization to expand emergency use of the Pfizer vaccine along with an independent CDC advisory panel’s assessment of the Pfizer clinical trials results among this age group. The Pfizer vaccine was previously approved for people age 16 and older.

More children getting COVID-19

Approving the vaccine for this group of preteens and teens is especially important now that children represent 14% of hospitalized U.S. COVID-19 patients, up from 2% a year ago, according to the American Academy of Pediatrics, which also released a statement encouraging vaccinations among this age group.

“As older adults have been immunized, we are now seeing a higher incidence of infection in the 6-to-14 and 14-to-17-year-old groups than in people age 80 and older,” said Cunningham, who also is pediatrician-in-chief and senior vice president for CHOC Children's Hospital of Orange County.

Some parents are already making plans for their adolescents to receive the Pfizer vaccine. Others, understandably, want more information.

In a recent survey, the Kaiser Family Foundation found that 29% of parents are hesitant to vaccinate their children under 18, with many citing the fact that the vaccines have only been given emergency use authorization by the FDA, not full approval.

Answering parents’ questions

Cunningham, who is renowned for her research on HIV and AIDS in children, explains the meaning of the FDA's emergency use authorization and answers other questions on parents' minds about the vaccine's safety.

Q. Is the vaccine safe for teens? Will my child get sick?
A. The FDA’s expanded emergency use authorization is based on results of a phase 3 clinical trial with 2,260 children ages 12 to 15; half received the Pfizer mRNA vaccine, the other received a saline placebo.

The immune response in the vaccinated adolescent group was even stronger than in the vaccinated 16-to-25-year-olds in an earlier study. The total number of symptomatic cases of COVID-19 reported in the trial was 16 — all in the placebo group. This means the vaccine was 100% effective in preventing COVID-19 in those that were vaccinated. 

We’ve seen this with a number of vaccines. Children have better immune systems than grown-ups. Often, the earlier you receive a vaccine, the better the immune response and the longer protection lasts.

Remember that in this country, vaccines are mostly given when we are children. And getting the vaccine helps your child get back to their normal life.

Q. Why vaccinate this age group if they don’t appear to suffer from severe cases of COVID-19?
A. Although the incidence of severe disease is far lower than in adults, it is not zero. Part of the reason we haven’t seen huge numbers of cases in children is because they weren’t congregating. They weren’t at daycare, school, sports and other group activities. As children return to normal activities, we would expect the incidence of infection to rise.

We also know that with many infectious diseases, the initial outbreak starts among children. We see this every year with the flu — it starts in kids and migrates to adults.

As children return to normal activities, we will see the coronavirus passed on. As more and more adults are immunized, unvaccinated kids will become a source of infection, passing it on to other kids, unimmunized adults and older adults who don’t have a good immune system.

Q. How do we know that the vaccine won’t cause long-term side effects?
A. The Pfizer vaccine is made from mRNA. It tells the body to generate the spike protein found on the surface of the novel coronavirus. The spike protein activates the immune response and generates antibodies that specifically fight the SARS-CoV-2 spike protein.

The vaccine doesn’t become integrated into your DNA. It doesn’t contain any live virus particles and it stays in your body a very short time, just long enough to generate an immune response.

If for some reason the antibodies you produce cause problems, the same thing would happen if you did get COVID-19. If you take your chances on getting the virus, you would also be at risk for severe or long-term COVID-19 infection.

These vaccines are incredibly safe. At this point, they have been given to millions of people around the world. Other than a sore arm and feeling tired for a few days, there have not been any reports of serious side effects in the majority of people.

Q. How do I prepare my child for the vaccine?
A. First of all, parents should get vaccinated themselves so they can show their child that they believe in the vaccine.

Second, show your teen the vaccine research. The data show that the vaccines are safe and will protect them from infection. Reassuring your teen of the vaccine's safety is a critical step.

Finally, let them know that this will help them return to all their activities — school, sports teams, school plays and seeing friends and family.

We’ve seen the harm done to children’s mental and emotional health by the pandemic, and all the experiences they’ve missed out on this past year. With the vaccine, they will soon be able to fully engage in life again.

Q. Are there side effects from the vaccine?
A. Vaccine-related side effects in the studies on children were similar to those experienced by adults. These include mild to moderate pain at the injection site, tiredness, headache, fever, chills, muscle and joint pain.

If your child is really uncomfortable after immunization, you can offer ibuprofen or acetaminophen. Do not give medication before the shot because that could interfere with the child's immune response.

Q. Will my child have to get COVID-19 immunizations to return to school and other activities?
A. I’m seeing indications that businesses and universities will require immunizations once the vaccines are fully approved by the FDA.

I haven’t seen any middle schools or high schools requiring it yet. But I do think it will happen to some extent in the future.

They may say, you can come to school without the vaccination but you will need to wear a mask and observe physician distancing. Schools could also limit participation in extracurricular activities for those without immunization.

Q. Is it safe to get the Pfizer vaccine at the same time as other immunizations?
A. No one has studied this yet. Until there is hard data, I recommend separating any other vaccines by a couple of weeks.

If your teenager is behind on routinely recommended vaccinations due to the pandemic or for other reasons, this would be a good time to work out a plan with your pediatrician to make sure they are caught up when school starts.

Coleen K. Cunningham, MD, is a UCI Health pediatrician who serves as chair of the UCI School of Medicine's Department of Pediatrics and senior vice president and pediatrician-in-chief at CHOC Children's Hospital of Orange County. As an educator, her focus has been on training physician-scientists in pediatric infectious diseases. The author of more than 130 published manuscripts, she also has led many multicenter clinical trials aimed at the treatment and prevention of HIV infection and other infectious diseases in children. She has received numerous competitive research grant awards and has served on National Institutes of Health grant review panels.

UCI Health is the clinical enterprise of the University of California, Irvine. Patients can access UCI Health at primary and specialty care offices across Orange County and at its main campus, UCI Medical Center in Orange, Calif. The 418-bed acute-care hospital, listed among America’s Best Hospitals by U.S. News & World Report for 20 consecutive years, provides tertiary and quaternary care, ambulatory and specialty medical clinics, as well as behavioral health and rehabilitation services. UCI Medical Center is home to Orange County’s only National Cancer Institute-designated comprehensive cancer centerhigh-risk perinatal/neonatal program and American College of Surgeons-verified Level I adult and Level II pediatric trauma center and regional burn center. It is the primary teaching hospital for the UCI School of Medicine. UCI Health serves a region of nearly 4 million people in Orange County, western Riverside County and southeast Los Angeles County. Follow us on Facebook and Twitter.