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Year : 2021  |  Volume : 7  |  Issue : 3  |  Page : 273-274

COVID-19 and Children − Prioritized Vaccination Lacks Evidence for Action

Department of Community Medicine, Maulana Azad Medical College, New Delhi, India

Date of Submission30-May-2021
Date of Decision11-Jun-2021
Date of Acceptance19-Nov-2021
Date of Web Publication03-Dec-2021

Correspondence Address:
Nandini Sharma
Room No. 323, Department of Community Medicine, Maulana Azad Medical College, New Delhi
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/mamcjms.mamcjms_55_21

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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.[1] 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.[2]

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.[3] 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.[4] The number of COVID-19 infections is least in children with 2% to 5% infections recorded in the <18 age group in India.[5] 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).[6] 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.[7] 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.[8]

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.[9] 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.[10] 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.

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Conflicts of interest

There are no conflicts of interest.

  References Top

Times of India. Covid-19 states gear up to protect kids as third wave fear lurks [Internet]. Available at https://timesofindia.indiatimes.com/india/covid-19-states-gear-up-to-protect-kids-as-third-wave-fear-lurks/articleshow/8299 5157.cms. Accessed May 29, 2021.  Back to cited text no. 1
NITI Aayog Myths & Facts on India’s Vaccination Process [Internet]. Available at https://pib.gov.in/PressReleasePage.aspx?PRID=1722078. Accessed May 29, 2021.  Back to cited text no. 2
Klass P, Ratner AJ. Vaccinating children against COVID-19-the lessons of measles. N Engl J Med 2021;384:589-91.  Back to cited text no. 3
Zimmermann P, Curtis N. Why is COVID-19 less severe in children? A review of the proposed mechanisms underlying the age-related difference in severity of SARS-CoV-2 infections. Arch Dis Child 2021;106:429-9.  Back to cited text no. 4
Jakhmola S, Baral B, Jha HC. A comparative analysis of COVID-19 outbreak on age groups and both the sexes of population from India and other countries. J Infect Dev Ctries 2021;15:333-41.  Back to cited text no. 5
Murhekar MV, Bhatnagar T, Thangaraj JWV et al. SARS-CoV-2 seroprevalence among the general population and healthcare workers in India, December 2020-January 2021. Int J Infect Dis 2021;108:145-55.  Back to cited text no. 6
Rao S, Gavali V, Prabhu SS et al. Outcome of children admitted with SARS-CoV-2 infection: experiences from a pediatric public hospital. Indian Pediatr 2021;58:358-62.  Back to cited text no. 7
Malhotra V, Basu S, Sharma N et al. Outcomes among 10, 314 hospitalized COVID-19 patients at a tertiary care government hospital in Delhi, India. J Med Virol 2021;93:4553-8.  Back to cited text no. 8
WHO. Tracking SARS-CoV-2 variants. Variants of concern and variants of interest, updatedMay 31, 2021 [Internet]. Available at https://www.who.int/en/activities/tracking-SARS-CoV-2-variants/. Accessed June 12, 2021.  Back to cited text no. 9
UNICEF. COVAX: ensuring global equitable access to COVID-19 vaccines [Internet]. Available at https://www.unicef.org/supply/covax-ensuring-global-equitable-access-covid-19-vaccines. Accessed dateJune 12, 2021.  Back to cited text no. 10


  [Table 1]


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