Dhe experts took their time. While in other countries all five to eleven-year-old children have been vaccinated against the corona virus for months, there was hesitation in this country. Until now, immunization had only been recommended for pre-existing children. The experts of the Standing Committee on Vaccination (Stiko) always pointed out that the data on vaccination effects and side effects in this age group was not yet sufficient.
But now Stiko has gotten its way: It also recommends a corona vaccination for healthy children between the ages of five and eleven. In contrast to adolescents and adults, however, children should initially only receive one mRNA vaccine dose and not several, according to a statement by the committee. The vaccination should “preferably” be carried out with Biontech’s Comirnaty vaccine. When vaccinated, children should be injected with ten micrograms – and not 30 micrograms like adults. According to the approval, the use of Spikevax (Moderna) for six to eleven year olds is also possible, Stiko said.
The panel of experts emphasizes that the vaccination recommendation is made as a precautionary measure because a renewed increase in corona infections is to be expected in autumn and winter. “The initial one-off vaccination aims to build up the best possible basic immunity.” If it should become necessary to improve vaccination protection, this can then be done quickly with a longer vaccination interval between the first and second vaccination.
Such a longer distance would then provide “a better protective effect and longer-lasting protection”, it said. The probability of heart muscle inflammation, myocarditis, after the second vaccination that may be necessary later, can be further reduced by a longer vaccination interval in this age group, in which the risk is already much lower than in adolescents and adults.
So far, the Stiko had only recommended vaccination for children between the ages of five and eleven if they themselves were previously ill or there were people in their immediate vicinity who were ill. Up until now, however, every child has been able to be vaccinated on request and after consultation with a doctor. Children with previous illnesses should continue to receive basic immunization with two vaccinations and a booster vaccination, according to Stiko in its updated recommendation.
Children without previous illnesses, in whose environment there are people at high risk of a severe course, should therefore receive a basic immunization with two vaccine doses. “Healthy children who have already received two vaccinations should not be vaccinated again for the time being,” the experts said.
The Stiko also promised that the question of whether it would be necessary to complete the basic immunization or a booster vaccination for children would be reassessed in late summer – or if the number of infections rose again.
Vaccination recommendations from Stiko are considered the medical standard and are an important guideline for many doctors. The Stiko had previously justified the lack of a general vaccination recommendation for the age group with the fact that there was a lack of data and that there was only a low risk of severe Covid 19 disease for healthy children. There has long been a general vaccination recommendation for children over the age of twelve, and no vaccine has yet been approved for children under five.
In addition, the Stiko also updated its recommendation for dealing with convalescents who are not yet fully vaccinated. Accordingly, people should also be vaccinated after one or more previous corona infections. An infection is therefore not enough to prevent future corona diseases.
According to scientific knowledge, solid protection against infection and serious illness is only possible by repeatedly dealing with the so-called spike protein of SARS-CoV-2. This is achieved either through basic immunization and boosters or through vaccination before or after an infection. A minimum time interval is important for adequate protection.
Martin Terhardt, pediatrician and Stiko member, explains: “This is a very serious and very responsible offer that we are making to parents to protect their five to eleven year olds even better now and in the future. Both children and parents had to experience enough anyway.”
He emphasizes that the one-off vaccination gives many children better protection – especially since many have already been infected. Such a mixture of infection and immunization leads to a so-called hybrid basic immunity. “This offers good protection for the further course of the disease and can possibly be supplemented later with another vaccination. But now it is important to first check the offer and, if possible, accept it: vaccinate once.”
Jörg Dötsch, Director of the Polyclinic for Pediatric and Adolescent Medicine at the University Hospital of Cologne and a member of the Federal Government’s Corona Expert Council, told WELT: “Stiko made a wise decision.” The data situation regarding the advantages and risks is despite the large vaccination campaigns still unclear in other countries. “The Stiko has therefore decided on a compromise.” The majority of the children have already been infected with the corona virus. However, a one-off infection does not lead to reliable basic immunity, just as little as a single vaccination dose. “So you evaluate an infection like a vaccine dose and add a vaccine dose – as a precaution against upcoming variants.”
Dötsch, who had repeatedly pointed out during the course of the pandemic that the focus had often been lost on the well-being of the children and had spoken out very early on in favor of keeping schools open – in compliance with hygiene and distance rules – says: “The decision is right in terms of the children, in terms of individual protection.”
Tim Niehues, chief physician at the Center for Pediatric and Adolescent Medicine at the Helios Klinikum in Krefeld, explains why vaccination also makes sense for children who have already recovered: In the case of a SARS-CoV-2 infection, there is not necessarily protection against infection. Several contacts with the virus are probably necessary so that the immune system is boosted and immunity then occurs. “Once children have been infected with SARS-CoV-2, a very high antibody response is observed in a subsequent vaccination.” Experts assumed that such hybrid immunity would result in better protection. But one always has to say that this data was only obtained in the laboratory, it is not data from studies on children.
In children, a corona infection is usually very mild, many do not even notice it. Frequently, an infection is only noticed through regular tests, for example in schools. “We have to assume that a very, very large number of children are infected,” says Niehues. “We can’t say exactly, but a very high percentage of children are likely to be infected by the more infectious omicron variant.” Only a very small proportion of children have probably not had any contact with the corona virus so far. So these children would have a certain pre-immunity “that will also protect against serious courses.”
Reinhard Berner, Director of the Clinic and Polyclinic for Pediatric and Adolescent Medicine at the University Hospital Dresden and external expert for Stiko, explains that vaccination is still recommended despite the high recovery rate in children: “You have to understand that this vaccination and this vaccination recommendation as preparation is intended for the coming autumn and winter. That’s how it’s designed, that’s how it’s intended and that’s how it makes sense from my point of view.”
It is true that more severe courses and also PIMS – Pediatric Inflammatory Multisystem Syndrome, a severe inflammatory reaction – occurred even less frequently with Omikron than with other corona variants. But in the past two years, people went in “relatively unprepared”. “You want to do that differently this year.” You want to protect the population as a whole from having to deal with many cases of illness next winter – “quite apart from all the secondary consequences of the pandemic and the effects.”
The children entered the third winter of the pandemic. The aim is to prepare this group for the autumn-winter season in advance. “We have to do everything we can to get them through this season better than the last two winters. All efforts are necessary for this, and this now includes this recommendation.”