|LETTER TO THE EDITOR
|Year : 2021 | Volume
| Issue : 3 | Page : 273-274
COVID-19 and Children − Prioritized Vaccination Lacks Evidence for Action
Nandini Sharma, Saurav Basu, Pragya Sharma
Department of Community Medicine, Maulana Azad Medical College, New Delhi, India
|Date of Submission||30-May-2021|
|Date of Decision||11-Jun-2021|
|Date of Acceptance||19-Nov-2021|
|Date of Web Publication||03-Dec-2021|
Room No. 323, Department of Community Medicine, Maulana Azad Medical College, New Delhi
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Sharma N, Basu S, Sharma P. COVID-19 and Children − Prioritized Vaccination Lacks Evidence for Action. MAMC J Med Sci 2021;7:273-4
|How to cite this URL:|
Sharma N, Basu S, Sharma P. COVID-19 and Children − Prioritized Vaccination Lacks Evidence for Action. MAMC J Med Sci [serial online] 2021 [cited 2022 Jan 28];7:273-4. Available from: https://www.mamcjms.in/text.asp?2021/7/3/273/331739
Several states in India which have borne the brunt of the second wave of the coronavirus disease 2019 (COVID-19) pandemic which resulted in large-scale morbidity and mortality have announced their preparedness plan for a possible third wave with focus on protecting children and adolescents. Simultaneously, there have been some isolated calls for prioritizing vaccination in young adolescents causing increased stress and anxiety in families despite the lack of any definitive recommendation by any health or medical organization.
People below 18 years of age constitute nearly 29.1% of the global population and achieving effective herd immunity through pediatric vaccination represents an ethical and policy dilemma considering the low impact of the COVID-19 upon children. Epidemiologic studies worldwide show that children and adolescents experience less severe forms of the COVID-19 and reduced mortality in comparison with adults probably due to differential immune and clotting function mechanisms apart from underdeveloped and fewer nasal angiotensin-converting enzyme 2 receptors. The number of COVID-19 infections is least in children with 2% to 5% infections recorded in the <18 age group in India. A nationwide serosurvey by the Indian Council of Medical Research in December 2020 estimated the seroprevalence in the 10 to17 age group to be 27.2% (95% confidence interval 24.9–29.4). We also conducted a state-wide serosurvey in Delhi, India in January 2021 that observed a high seroprevalence of severe acute respiratory syndrome coronavirus 2 immunoglobulin G in all the child and adolescent age groups from 5 to 17 years signifying the clinical spectrum of infection was asymptomatic or mild in most cases [Table 1]. The comparatively higher seroprevalence estimates in Delhi was likely because of the high population density especially in the slum and resettlement colony populations.
|Table 1 Distribution of seropositivity (IgG) in children in Delhi, January 2021 (N = 4290)|
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Even in the children having moderate-severe COVID-19 disease and needing hospitalization, the risk of death is low and mostly concentrated in those with underlying illnesses. A study from Mumbai reported a case fatality rate of 11.4% (n = 969) among hospitalized children. In contrast, moderate-severe adult COVID-19 cases hospitalized at a tertiary care hospital in Delhi had a comparatively higher case fatality rate (13.7%) with most deaths occurring after the age of 40.
During the second wave of the pandemic in India leading to a massive surge in cases, newer COVID-19 strains especially the B.1.617 (Delta) have been implicated to confer increased infectiousness and potential virulence in the viral agent. Nevertheless, there is no evidence till date to suggest that the Delta strain has greater propensity to infect or cause severe disease in children.
In conclusion, the expansion of vaccination coverage to achieve herd immunity in the overall population is an ethical imperative for governments to halt the COVID-19 pandemic. Limited vaccine stocks globally especially in developing countries signify the need to equitably distribute vaccines to the most vulnerable populations. Consequently, people with comorbidities, older people, middle-aged adults and finally young adult people continue to warrant a substantially higher vaccine prioritization compared to children due to the likely protection accorded against severe disease in the former. The development of safe and effective COVID-19 vaccines for children after rigorous clinical trials that are able to reduce disease transmission is also necessary to make a case for ramping vaccine coverage in this cohort which is otherwise significantly less vulnerable to adverse disease outcomes.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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