Dr. William Fredette: A Guide to COVID-19 Vaccinations for Kids

With multiple COVID-19 vaccines now offering hope for a return to normal life, it's not surprising that opinions about their safety and appropriate use have sprung up on all sides. And now that the Pfizer vaccine has been approved for use in older children, parents have the tough job of separating the facts from the noise as they try to make the best decisions for their kids.

Why the new age recommendation?

The COVID-19 vaccines were first studied in adults. Pediatricians like to say that children are not just small adults. Because medications and vaccines can behave differently in kids, more studies were needed. The results now available show that the Pfizer vaccine is just as safe, and perhaps even more effective, for children aged 12 and older, so its permitted use has been expanded to include that age group.

How does the vaccine work?

Dr. William Fredette
Dr. William Fredette, Medical Director of Oneonta Fox Pediatrics

To understand how vaccines work in general, think of a bloodhound tracking its quarry. When you want the dog to find someone, you might give it a piece of clothing with that person's scent. Vaccines work in a similar way. They present the body's immune cells with a piece of a virus – for example, a particular protein from the virus' shell. Using that piece, the body's immune cells make antibodies which, like tiny bloodhounds, can recognize the actual virus if it ever appears.
 
But what about mRNA vaccines like the ones we're using against COVID-19? This is where the high school biology you thought you'd never use again comes in handy. You might recall that (almost) all of our cells contain DNA, which is the "blueprint" for our bodies. When we need a specific protein to be made, the DNA unzips a bit, and messenger RNA, or mRNA, makes a copy of the instructions to build that protein. It then carries those instructions out of the nucleus into the cytoplasm (the liquid portion of space inside our cells) where the protein is put together. For the mRNA, the trip from the nucleus is one way. Once the protein is built, the mRNA is broken down.

mRNA in the Pfizer and Moderna vaccines carries instructions for building a particular protein that exists on the SARS-CoV-2 virus, the virus that causes COVID-19. The vaccines are injected into the upper arm, where muscle cells manufacture the protein. They then display the protein on their surfaces, where immune cells can "see" it and make antibodies which will protect against the virus. When its job is done, the mRNA is broken down. It does not remain in the cell, and does not enter the nucleus. There is no way you can get COVID-19 from the vaccines, because they do not contain any virus at all.

What about the things I've read on Facebook?

Many of the concerns people have about COVID-19 vaccines arise from the fact that they are new. They were developed at a remarkable pace as the pandemic worsened. It's important to know, though, that the vaccines have been tested extensively for safety, and the technology behind them has been known and studied for decades. mRNA vaccines have been researched for infections ranging from the flu to rabies. mRNA has also been used to treat cancer, given its ability to target malignant cells.

There are also rumors about the vaccines rooted in misunderstanding of their use of genetics. Though the Pfizer and Moderna vaccines make use of our cells' ability to create virus proteins, they do not enter the nucleus of the cell or interact with our DNA in any way. And, again, the mRNA is broken down and eliminated once it has done its job. These vaccines do not, and cannot, affect reproductive function or cause sterility, as some have suggested. Infection with the COVID-19 virus, on the other hand, has been shown to have potential reproductive effects in both men and women.

Should my child have the vaccine?

The short answer is yes. The American Academy of Pediatrics "recommends COVID-19 vaccination for all children and adolescents 12 years of age and older who do not have contraindications to using a COVID-19 vaccine authorized for use for their age."

The more nuanced answer is also yes. Vaccination is especially important for high-risk children, including those with asthma, diabetes, underlying heart or lung problems and obesity. For children without those conditions, vaccination helps prevent spreading COVID-19 to friends and family members who might be at risk of severe complications from the infection. Beyond that, and perhaps most important to kids, proof of vaccination may make it easier to return to sports and other group activities that they've been missing for so long.

Where can I find more information?

Your child's doctor is the best source of trusted information about vaccines. Useful online sources include the American Academy of Pediatrics website (www.aap.org) and the Centers for Disease Control & Prevention (CDC – www.cdc.gov).


Dr. William Fredette is Medical Director at Oneonta Pediatrics.

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