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Importance of COVID-19 Vaccination in Children: viewpoint and recommendations of the Union of European National Societies of Pediatrics

  • Massimo Pettoello-Mantovani
    Correspondence
    Corresponding Author: Massimo Pettoello-Mantovani, MD, PhD Department of Pediatrics, Scientific Institute “Casa Sollievo della Sofferenza”, University of Foggia, Foggia, Italy, - Phone:+39.0881588099 / FAX: +39.0881.733718
    Affiliations
    European Paediatric Association/Union of National European Paediatric Societies and Associations (EPA/UNEPSA), Berlin, Germany;

    Association pour l’Activité et la Recherche Scìentifiques, Nouchatel, Switzerland

    Italian Academy of Pediatrics, Milan, Italy;

    Department of Pediatrics, University of Foggia, “Casa Sollievo” Scientific Institute, San Giovanni Rotondo, Italy,
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  • Cristina Cardemil
    Affiliations
    United States Public Health Service, Division of Microbiology and Infectious Diseases. National Institute of Allergy and Infectious Diseases, National Institutes of Health (NIH), Rockville, Maryland
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  • Robert Cohen
    Affiliations
    Pediatric Infectious Disease Group (GPIP), Créteil, France

    Association Clinique et thérapeutique Infantile du Val de Marne, Créteil, France

    Paris Est University, IMRB-GRC GEMINI, Créteil, France
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  • Corinne Lev
    Affiliations
    Pediatric Infectious Disease Group (GPIP), Créteil, France

    Association Clinique et thérapeutique Infantile du Val de Marne, Créteil, France

    Paris Est University, IMRB-GRC GEMINI, Créteil, France
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  • Ida Giardino
    Affiliations
    Department of Biomedical Sciences, University of Foggia, Foggia, Italy;
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  • Flavia Indrio
    Affiliations
    Department of Pediatrics, University of Foggia, “Casa Sollievo” Scientific Institute, San Giovanni Rotondo, Italy,
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  • Eli Somekh
    Affiliations
    European Paediatric Association/Union of National European Paediatric Societies and Associations (EPA/UNEPSA), Berlin, Germany;

    Association pour l’Activité et la Recherche Scìentifiques, Nouchatel, Switzerland

    Department of Pediatrics, Mayanei Hayeshuah Medical Center, Bnei Brak, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

    Israel Pediatric Society, Tel Aviv, Israel
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Published:December 29, 2021DOI:https://doi.org/10.1016/j.jpeds.2021.12.066

      ABBREVIATIONS:

      Food and Drug Administration ((FDA)), European Medicine Agency ((EMA)), Coronavirus disease 2019 ((COVID-19)), Severe Acute Respiratory Syndrome Coronavirus ((SARS-CoV-2)), The European Pediatric Association/Union of National European Paediatric Societies and Associations ((EPA-UNEPSA)), US National Institute of Health ((NIH)), Centers for Disease Control and Prevention ((CDC))
      Coronavirus disease 2019 (COVID-19) vaccines, approved by the U.S. Food and Drug Administration

      US Food and Drug Administration. Coronavirus Disease 2019 (COVID-19). https://www.fda.gov/emergency-preparedness-and-response/counterterrorism-and-emerging-threats/coronavirus-disease-2019-covid-19. (Accessed, 24.11.2021)

      (FDA) and the European Medicine Agency

      European Medicine Agency. COVID-19 Pandemic. https://www.ema.europa.eu/en (Accessed, 24.11.2021)

      (EMA) have been shown to be safe and effective

      Cheng H., Peng Z., Luo W., Si S., Mo M., Zhou H.et al. Efficacy and Safety of COVID-19 Vaccines in Phase III Trials: A Meta-Analysis. Vaccines 2021, 9, 582. https://doi.org/10.3390/vaccines9060582

      ,

      Center for Disease Control and Prevention. Demographic Trends of People Receiving COVID-19 Vaccinations in the United States . https://covid.cdc.gov/covid-data-tracker/#vaccination-demographics-trends (Accessed, 22 December 2021)

      in the adult population at preventing severe disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) worldwide

      Fowlkes A, Gaglani M, Groover K, Thiese MS, Tyner H, Ellingson K. HEROES-RECOVER Cohorts. Effectiveness of COVID-19 Vaccines in Preventing SARS-CoV-2 Infection Among Frontline Workers Before and During B.1.617.2 (Delta) Variant Predominance - Eight U.S. Locations, December 2020-August 2021. MMWR Morb Mortal Wkly Rep. 2021 Aug 27;70(34):1167-1169. doi: 10.15585/mmwr.mm7034e4. PMID: 34437521; PMCID: PMC8389394.

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      Prevention and attenuation of Covid-19 with the BNT162b2 and mRNA-1273 vaccines.
      . The use of COVID-19 vaccination in children aged 12-17 years old has been the subject of extensive debate, as the assessment of risks and benefits was considered more complex than in adults

      Zimmermann P, Pittet LF, Finn A, Pollard AJ, Curtis N. Should children be vaccinated against COVID-19?Archives of Disease in Childhood Published Online First: 03 November 2021. doi: 10.1136/archdischild-2021-32304

      ,
      • Pettoello-Mantovani M.
      • Carrasco-Sanz A.
      • Huss G.
      • Mestrovic J.
      • Vural M.
      • Pop T.L.
      • et al.
      Viewpoint of the European Pediatric Societies over Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Vaccination in Children Younger Than Age 12 Years Amid Return to School and the Surging Virus Variants.
      . Different circumstances were taken into account including common reactions, infrequent serious side effects, possible impact on routine immunization programs, as well as vaccine supply and cost of vaccination

      Robert C, Pettoello-Mantovani M, Somekh E, Levy C. European pediatric societies call for an implementation of regular vaccination programs to contrast the immune debt associated to COVID-19 pandemic in children. Journal of Pediatrics. November 26, 2021. DOI:https://doi.org/10.1016/j.jpeds.2021.11.061 (Accessed, 07.12.2021)

      . However, COVID-19 vaccines for individuals of this age group were authorized, initially for emergency use and later approved by the stringent regulatory authorities FDA and EMA, and have since been adopted with widespread use in several countries worldwide
      • Franck R.W.
      • Klein N.P.
      • Kitchin N.
      • Gurtman A.
      • Absalon J.
      • Lockhartet S al
      Safety, immunogenicity, and efficacy of the BNT162b2 Covid-19 vaccine in adolescents.
      . Additionally, both the FDA and EMA, in October/November 2021 have authorized the use of COVID-19 vaccines in children 5-11 years of age. Their approval followed a thorough evaluation process demonstrating the same high standards of quality, safety, immunogenicity and efficacy observed in the older populations

      Center for Disease Control and Prevention (CDC). CDC Recommends Pediatric COVID-19 Vaccine for Children 5 to 11 Years. https://www.cdc.gov/media/releases/2021/s1102-PediatricCOVID-19Vaccine.html (Accessed, 07.12. 2021)

      ,

      Haelle T. COVID Vaccine Authorized for Kids Aged 5 to 11. Scientific American. https://www.scientificamerican.com/article/covid-vaccine-authorized-for-kids-aged-5-to-111/ (Accesses, 07.12.2021)

      . COVID data tracking indicates that in the US 20.1% of the 5-11yo population have received at least one dose of COVID-19 vaccine by December 16th. The percentage of fully vaccinated subjects in the 5-11yo group is 11.3%; 62.3% of adolescents 12-17yo have received at least one dose of COVID-19 vaccine

      Center for Disease Control and Prevention. Demographic Trends of People Receiving COVID-19 Vaccinations in the United States . https://covid.cdc.gov/covid-data-tracker/#vaccination-demographics-trends (Accessed, 22 December 2021)

      .
      In Europe the debate over the extension of the use of COVID-19 vaccine in children <17 years old is ongoing. The 27 member states of the European Union showed different views and adopted divergent policies. It is unclear whether a unitary position will eventually be taken by the EU and non-EU countries on the use of COVID-19 vaccination in individuals <17 years of age. In the meantime, the European Centre for Disease Control and Prevention (ECDC) reported that in the first week of December 2021 only 20.8% of the European population aged 12-17 received at least one dose of vaccine, while no vaccinations were reported in children 5-11 years old

      European Centers for Disease Control and Prevention (ECDC). COVID-19 Vaccine Tracker. https://vaccinetracker.ecdc.europa.eu/public/extensions/COVID-19/vaccine-tracker.html#age-group-tab. (Accesses, 07.12.2021)

      .
      This commentary discusses the importance of implementing SARS-CoV-2 vaccination in children ). The European Pediatric Association/Union of National European Paediatric Societies and Associations (EPA-UNEPSA) joins the US National Institute of Health (NIH), to advocate and raise awareness of pediatricians, lawmakers, public health officers and school educators on the importance of COVID-19 vaccination in these two groups of population. Vaccination of children and adolescents will protect them from the risks of SARS-CoV-2 infection and its short and long term complications
      • Radtke T.
      • Ulyte A.
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      Long-term Symptoms after SARS-CoV-2 Infection in Children and Adolescents.
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      National Institute of Health (NIH). Long-term study of children with COVID-19 begins. NIH-supported research will track effects of COVID-19 infection on children over three years. https://www.nih.gov/news-events/news-releases/long-term-study-children-covid-19-begins (Accesses, 07.12.2021)

      .

      Importance of COVID-19 vaccination in children 12-17 years old

      COVID-19 vaccination in children 12-17 years old is recommended by the US and European regulatory Authorities

      US Food and Drug Administration. Coronavirus Disease 2019 (COVID-19). https://www.fda.gov/emergency-preparedness-and-response/counterterrorism-and-emerging-threats/coronavirus-disease-2019-covid-19. (Accessed, 24.11.2021)

      ,

      European Medicine Agency. COVID-19 Pandemic. https://www.ema.europa.eu/en (Accessed, 24.11.2021)

      . Available studies on SARS-CoV-2 seroprevalence and viral shedding are unable to establish conclusively whether adolescents are infected at the same rate as adults

      World Health Organization. Interim statement on COVID-19 vaccination for children and adolescents. https://www.who.int/news/item/24-11-2021-interim-statement-on-covid-19-vaccination-for-children-and-adolescents. (Accessed, 13 December 2021)

      . Data on transmission from children to others are limited; some studies suggest similar infection rates, while others indicate lower infection rates among children. Early in the pandemic, some studies estimated that adults might have higher susceptibility to infection compared with individuals below 20 years of age

      Davies NG, Klepac P, Liu Y, Prem K, Jit M, CMMID COVID-19 working group et al. Age-dependent effects in the transmission and control of COVID-19 epidemics. Nat Med 2020;26(8):1205–1211.

      . However, recent data in the US indicate that children have a higher seroprevalence than adults, and the infection to case ratio is higher in children. Children and adolescents are known to spread the virus to other age groups and secondary transmission from children has been documented in both household and school settings
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      A cross-sectional and prospective cohort study of the role of schools in the SARS-CoV-2 second wave in Italy.
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      • et al.
      Household Transmission of SARS-CoV-2 from Children and Adolescents.
      . In early studies, children and adolescents represented a smaller proportion of symptomatic subjects and showed a reduced number of cases of severe disease and deaths due to SARS-CoV-2 infection compared with older age groups21.22. However, the combination of mild and asymptomatic infection and reduced care seeking in younger age groups are likely contributors to undertesting and underreporting of cases

      World Health Organization. COVID-19 disease in children and adolescents. file:///C:/Users/Mantovani/Downloads/WHO-2019-nCoV-Sci-Brief-Children-and-adolescents-2021.1-eng%20(1).pdf (Accessed, 13 December 2021)

      . deficient monitoring of SARS-CoV-2 in this age population

      World Health Organization. Recognizing adolescence. https://apps.who.int/adolescent/second-decade/section2/page1/recognizing-adolescence.html (Accesses, 08.12.2021)

      suggests that adolescents may remain largely undetected and therefore have a role in SARS-CoV-2 transmission. Intense social relations characterizing adolescence may be an additional factor contributing to the viral spread. Data fromIndia reported the seropositivity rate for the Delta variant in children 6-18 years was comparable with that in older age groups

      World Health Organization. Interim statement on COVID-19 vaccination for children and adolescents. https://www.who.int/news/item/24-11-2021-interim-statement-on-covid-19-vaccination-for-children-and-adolescents. (Accessed, 13 December 2021)

      .
      In the US the proportion of cases in children has significantly increased from the 2.6% observed in the beginning of the pandemic to about 24% of all cases

      American Academy of Pediatrics. Children and COVID-19: State-Level Data Report https://www.aap.org/en/pages/2019-novel-coronavirus-covid-19-infections/children-and-covid-19-state-level-data-report/ (Accessed, 22 December 2021) .

      . Recent data indicate a 38-40% seroprevalence rate in children aged 5-17 years old, which was higher compared with adults and older adults

      Center for Disease Control and Prevention (CDC). CDC Recommends Pediatric COVID-19 Vaccine for Children 5 to 11 Years. https://www.cdc.gov/media/releases/2021/s1102-PediatricCOVID-19Vaccine.html (Accessed, 07.12. 2021)

      ,

      Center for Disease Control and Prevention (CDC). Covid data tracker. Demographic Characteristics of People Receiving COVID-19 Vaccinations in the United States. https://covid.cdc.gov/covid-data-tracker/#vaccination-demographic (Accesses, 07.12.2021)

      . Similar data are reported in EU countries

      European Centre for Disease Prevention and Control. ECDC report outlines considerations for COVID-19 vaccination of adolescents. https://www.ecdc.europa.eu/en/news-events/ecdc-report-outlines-considerations-covid-19-vaccination-adolescents. (Accessed, 13 December 2021)

      . Additionally, the median number of infections per reported case for children <17 years old was 6.2, compared with the general population, with a median of 2.4 infections per reported case. Data reported by WHO also suggest that SARS-CoV-2 infection rates in children, adolescents and adults are similar

      World Health Organization. Interim statement on COVID-19 vaccination for children and adolescents. https://www.who.int/news/item/24-11-2021-interim-statement-on-covid-19-vaccination-for-children-and-adolescents. (Accessed, 13 December 2021)

      and ECDC reports that test positivity among the 10-19 year old age group mirror those of most other age groups

      European Centre for Disease Prevention and Control. ECDC report outlines considerations for COVID-19 vaccination of adolescents. https://www.ecdc.europa.eu/en/news-events/ecdc-report-outlines-considerations-covid-19-vaccination-adolescents. (Accessed, 13 December 2021)

      . Collectively, these data indicate that children and adolescents are at least as likely as adults to be infected with SARS-CoV-2, but are less likely to be reported
      The risk of complications due to SARS-CoV-2 infection in the pediatric population supportimplement COVID-19 vaccination in children and adolescents
      • Anderson E.J.
      • Campbell J.D.
      • Creech C.B.
      • Frenck R.
      • Kamidani S.
      • Munoz F.M.
      • et al.
      Wrap speed for Coronavirus Disease 2019 (COVID-19) Vaccines: Why Are Children Stuck in Neutral?.
      . Multisystem inflammatory syndrome (MISC), long-COVID-19, indirect effects on mental health and education are among the serious conditions which can be caused by even mild COVID-19, particularly in subjects with underlying medical conditions

      Geva A, Patel MM, Newhams MM, Young CC, Son MBF, Kong Met al Overcoming COVID-19 Investigators. Data-driven clustering identifies features distinguishing multisystem inflammatory syndrome from acute COVID-19 in children and adolescents. EClinicalMedicine. 2021 Oct;40:101112. doi: 10.1016/j.eclinm.2021.101112. Epub 2021 Aug 31. PMID: 34485878; PMCID: PMC8405351.

      ,

      Jones J. Severity of disease, ICU admission rate, and comparison with influenza. ACIP Meeting. November 2, 2021 www.cdc.gov/vaccines/acip/meetings/downloads/slides-2021-11-2-3/03-COVID-Jefferson-508.pdf (Accessed, 22 December, 2021)

      . In the US, approximately one-third of those <17 years old who are hospitalized with COVID-19 require ICU admission, and severity of illness for hospitalized cases is comparable with influenza. Although MISC is relatively infrequent in subjects affected by COVID-19, studies from Europe and North America have reported groups of adolescents requiring admission to intensive care units due to multisystem inflammatory conditions and toxic shock syndrome

      Jones J. Severity of disease, ICU admission rate, and comparison with influenza. ACIP Meeting. November 2, 2021 www.cdc.gov/vaccines/acip/meetings/downloads/slides-2021-11-2-3/03-COVID-Jefferson-508.pdf (Accessed, 22 December, 2021)

      . COVID-19 is currently among the top 10 causes of death for children in this country

      World Health Organization. COVID-19 disease in children and adolescents. file:///C:/Users/Mantovani/Downloads/WHO-2019-nCoV-Sci-Brief-Children-and-adolescents-2021.1-eng%20(1).pdf (Accessed, 13 December 2021)

      ,

      World Health Organization. Multisystem inflammatory syndrome in children and adolescents temporally related to COVID-19. https://www.who.int/news-room/commentaries/detail/multisystem-inflammatory-syndrome-in-children-and-adolescents-with-covid-19 (Accessed, 09.12.2021)

      .; Value of COVID-19 vaccination in children 5-11 years old
      In the US, after the Centers for Disease Control and Prevention (CDC) recommended COVID-19 vaccination for children ages 5-11 in November 2021

      Center for Disease Control and Prevention. COVID-19 Vaccination for Children 5 through 11 Years Old. https://www.cdc.gov/vaccines/covid-19/planning/children.html (Accessed, 12 December 2021)

      , distribution of pediatric doses of the vaccine to pediatric offices, pharmacies, and health centers was scaled up rapidly toward full capacity. The COVID-19 vaccine in children in this age group was also approved by Health Canada, and in the first week of December 2021 17.5% of individuals in this age range received at least one dose

      Health Canada. Coronavirus disease (COVID-19). https://www.canada.ca/en/public-health/services/diseases/coronavirus-disease-covid-19.html (Accessed, 12 December 2021)

      . The European Medicines Agency approved the use of COVID-19 vaccine for children aged 5-11 in November 2021, and the rollout in this age group started in Italy and France in December 2021

      Moussu N. Euractive. France opens vaccination to 360,000 at-risk children. https://www.euractiv.com/section/politics/short_news/france-opens-vaccination-to-360000-at-risk-children/ (Accessed, 12 December 2021)

      ,

      Lazio Region. Salute Lazio. From December 13 vaccination anti COVID-19 starts in children 5-11 years old. https://www.salutelazio.it/vaccinazione-covid-19-fascia-5-11-anni (Accessed, 12 December 2021)

      . It is important to ensure that all school-aged children <12 years are protected from COVID-19 infection

      Burkhalter B. UAB epidemiologist: South Africa sees child hospitalizations surge amid omicron variant. https://www.alreporter.com/2021/12/08/uab-epidemiologist-south-africa-seeing-surge-in-child-hospitalizations-amid-omicron-variant/ (Accessed, 13 December 2021)

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      Callaway E. Beyond Omicron: what’s next for COVID’s viral evolution. Nature. News feature. https://www.nature.com/articles/d41586-021-03619-8 (Accessed, 13 December 2021)

      .
      Approvals by regulatory authorities in the US and Europe were based on evidence that the efficacy and immunogenicity of these vaccines are as high as those in older individuals and show rare serious adverse effects

      Center for Disease Control and Prevention. COVID-19 Vaccination for Children 5 through 11 Years Old. https://www.cdc.gov/vaccines/covid-19/planning/children.html (Accessed, 12 December 2021)

      . Myocarditis associated with mRNA COVID-19 vaccines is a sporadic adverse event predominantly seen in male adolescents and young adults following the second vaccine dose, which has raised concern about this risk in younger children. However, based on available data from the years preceding COVID-19, the risk of vaccine-associated myocarditis in 5-11-year-olds is expected to be extremely low compared with adolescents and young adults, in whomsuch risk is already low

      Olivier S. CDC: Evidence to Recommendations (EtR) Framework:Pfizer-BioNTech COVID-19 vaccine in children aged 5–11 years. https://www.cdc.gov/vaccines/acip/meetings/downloads/slides-2021-11-2-3/08-COVID-Oliver-508.pdf (Accessed , 12 December, 2021).

      . We still do not have long term outcome data on myocarditis following vaccination. However, preliminary survey data at three months following diagnosis showed that 52% reported no symptoms within the prior two weeks

      Singer ME, Ira B. Taub, David C Kaelber. Risk of Myocarditis from COVID-19 Infection in People Under Age 20: A Population-Based Analysis. medRxiv 2021.07.23.21260998; doi: https://doi.org/10.1101/2021.07.23.21260998

      ,

      Boehmer TK, Kompaniyets L, Lavery AM, Hsu J, Ko JY, Yusuf H. Association Between COVID-19 and Myocarditis Using Hospital-Based Administrative Data — United States, March 2020–January 2021. https://www.cdc.gov/mmwr/volumes/70/wr/mm7035e5.htm?s_cid=mm7035e5_w (Accessed, 22 December 2021)

      . The advantages of vaccination are considered to largely outweigh this risk, as the occasional cases of myocarditis associated with COVID-19 vaccination are predominantly mild and the risk of myocarditis following COVID-19 is higher than the risk of myocarditis after COVID-19 vaccination

      Singer ME, Ira B. Taub, David C Kaelber. Risk of Myocarditis from COVID-19 Infection in People Under Age 20: A Population-Based Analysis. medRxiv 2021.07.23.21260998; doi: https://doi.org/10.1101/2021.07.23.21260998

      ,

      Boehmer TK, Kompaniyets L, Lavery AM, Hsu J, Ko JY, Yusuf H. Association Between COVID-19 and Myocarditis Using Hospital-Based Administrative Data — United States, March 2020–January 2021. https://www.cdc.gov/mmwr/volumes/70/wr/mm7035e5.htm?s_cid=mm7035e5_w (Accessed, 22 December 2021)

      ,

      Yang H. Food and Drug Administration (FDA) Vaccines and Related Biological Products Advisory Committee (VRBPAC). Benefits-Risks of Pfizer-BioNTech COVID-19 Vaccine for Ages 5 to 11 Years. https://www.fda.gov/media/153507/download (Accessed , 12 December, 2021).

      ,
      • Salzman M.B.
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      Multisystem Inflammatory Syndrome after SARS-CoV-2 Infection and COVID-19 Vaccination.
      .
      The rare cases of MISC reported in adults following COVID-19 vaccination advised the importance of monitoring for this possible adverse event in children 5-11 years old.. However, data from vaccine trials in children <12 years old have not identified any potential signal triggering this event

      Yang H. Food and Drug Administration (FDA) Vaccines and Related Biological Products Advisory Committee (VRBPAC). Benefits-Risks of Pfizer-BioNTech COVID-19 Vaccine for Ages 5 to 11 Years. https://www.fda.gov/media/153507/download (Accessed , 12 December, 2021).

      . It is also important to take into account that the number of children 5-11 years old who have died due to COVID-19 during the pandemic, is higher than the mortality rates of the infections for which children were routinely vaccinated before COVID-19 vaccines were made available, including meningococcal disease, measles, varicella and rotavirus

      Olivier S. CDC: Evidence to Recommendations (EtR) Framework:Pfizer-BioNTech COVID-19 vaccine in children aged 5–11 years. https://www.cdc.gov/vaccines/acip/meetings/downloads/slides-2021-11-2-3/08-COVID-Oliver-508.pdf (Accessed , 12 December, 2021).

      . The risk of severe disease in children with underlying medical conditions, and the importance of protecting children from any severe outcome related to COVID-19 infection are all compelling reasons for vaccination of children 5 to 11 years old

      Olivier S. CDC: Evidence to Recommendations (EtR) Framework:Pfizer-BioNTech COVID-19 vaccine in children aged 5–11 years. https://www.cdc.gov/vaccines/acip/meetings/downloads/slides-2021-11-2-3/08-COVID-Oliver-508.pdf (Accessed , 12 December, 2021).

      ,

      Cohen R, Pettoello-Mantovani M, Somekh E, Levy C. European pediatric societies call for an implementation of regular vaccination programs to contrast the immune debt associated to COVID-19 pandemic in children [published online ahead of print, 2021 Nov 27]. J Pediatr. 2021;S0022-3476(21)01159-8. doi:10.1016/j.jpeds.2021.11.061

      Conclusions

      Although children and adolescents with COVID-19 show generally less frequent and severe symptoms, they acquire and spread the coronavirus and present with clinical complications including hospitalization and death.
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      Laws RL, Chancey RJ, Rabold EM, Chu VT, Lewis NM, Fajans M, et al. Symptoms and Transmission of SARS-CoV-2 Among Children - Utah and Wisconsin, March-May 2020. Pediatrics. 2021 Jan;147(1):e2020027268. doi: 10.1542/peds.2020-027268. Epub 2020 Oct 8. PMID: 33033178.

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      Lee B, Raszka WV Jr. COVID-19 in Children: Looking Forward, Not Back. Pediatrics. 2021 Jan;147(1):e2020029736. doi: 10.1542/peds.2020-029736. Epub 2020 Oct 8. PMID: 33033179.

      . The UNEPSA joins the American Academy of Pediatrics and NIH in welcoming the decision of the US and European regulatory authorities to authorize COVID-19 vaccination in children and adolescents who do not have contraindications using a COVID-19 vaccine authorized for use for their age
      American Academy of Pediatrics Committee on Infectious Diseases
      COVID-19 Vaccines in Children and Adolescents.
      . EPA-UNEPSA recommends the implementation of COVID-19 vaccination programs in these age groups

      Pettoello-Mantovani M, Carrasco-Sanz A, Huss G, , Mestrovic J, Vural M, Pop TLet al. Viewpoint of the European Pediatric Societies over Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Vaccination in Children Younger Than Age 12 Years Amid Return to School and the Surging Virus Variants. J Pediatr. 2021;239:250-251.e2. doi:10.1016/j.jpeds.2021.09.013

      in order to protect children and adolescents’ health and allow them to fully engage in all of the activities that are essential for their full development and wellbeing
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      . Vaccinated children and adolescents would not be exposed to the adverse mental and behavioral consequences associated with isolation, quarantine and missing of school

      Jiao WY, Wang LN, Liu J, Fang SF, Jiao FY, Pettoello-Mantovani M, Somekh E.Behavioral and Emotional Disorders in Children during the COVID-19 Epidemic. J Pediatr. 2020 Jun;221:264-266.e1

      .
      In the EU, data from December 2021 show a 96% weekly increase of children hospitalized with laboratory-confirmed COVID-19, of whom 69% were < 4 years old, strongly suggesting the importance of COVID-19 vaccination in younger children

      Jiao WY, Wang LN, Liu J, Fang SF, Jiao FY, Pettoello-Mantovani M, Somekh E.Behavioral and Emotional Disorders in Children during the COVID-19 Epidemic. J Pediatr. 2020 Jun;221:264-266.e1

      . Vaccine trials in children ages 6 months to 5 years are underway in the USunder careful supervision by the FDA and key data are expected to be released in the coming months.

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