Front Burner - COVID-19 vaccines for kids: what you need to know

Episode Date: November 26, 2021

Since the first pediatric Pfizer vaccines landed in Canada last weekend, provinces have been moving fast to get them into arms. Children got their first jabs in Ontario on Tuesday; more kids started being vaccinated in Quebec, Manitoba and Saskatchewan on Wednesday; and the rollout continues to expand. Today we’re joined by Dr. Fatima Kakkar, an infectious diseases pediatrician at the research centre of the Centre Hospitalier Universitaire Sainte-Justine and an assistant professor in the Department of Pediatrics at the Université de Montréal. She breaks down what’s happening with these shots, how they work on kids and what to expect from the rollout.

In the Dragon's Den, a simple pitch can lead to a life-changing connection. Watch new episodes of Dragon's Den free on CBC Gem. Brought to you in part by National Angel Capital Organization, empowering Canada's entrepreneurs through angel investment and industry connections. This is a CBC Podcast. Hello, I'm Angela Starrett. Let me tell you, Monday is going to be a big day in the Starrett House. That's when the BC government is going to start sending out invites to families with kids aged 5 to 11 to get their COVID-19 vaccines.

My son is 11, and I've had him registered for this since October 4th. Both of us are stoked for this moment. For him, it's a weight off his shoulders. He's had friends get sick with COVID, and he doesn't want to get it too. For me, well, seeing my son get the vaccine is also really critical to me, not just as a mom, but as an Indigenous person who's part of many communities filled with elders and immunocompromised people, people who I don't want to get sick. I've been thinking about this ever since the first pediatric Pfizer vaccines landed in Canada this past weekend. Provinces have been moving fast to get them into arms.

The first 10 kids got their jabs in Ontario on Tuesday. More kids in Quebec, Manitoba and Saskatchewan started getting jabs on Wednesday. To break down what's happening with these shots, how they work, and what's happening with the federal rollout, we're talking to Dr. Fatima Kakar. She's a pediatric infectious disease specialist based in Montreal. Hi, Fatima. Hello. So how are you feeling knowing that the vaccine is now going to be available to kids in this younger age group? I think it's such a great thing. And this is the

age group right now that's having the most number of infections. And really, the rest of the world has all gone on and things have gone back to normal. But we have to realize that for the under 12s, life has really not gone back to normal. And so this gives them the security and really the ability to go back to the activities and really the socialization that's so essential for their health. So I'm very excited for the under 12s. You know, we hear a lot about how resilient kids are, but what have you seen from kids struggling with their mental health during this pandemic? According to recent studies, there has been a 17% jump in anxiety diagnoses in

children 17 and younger over the past 10 years. The indirect impact this pandemic is having on our nation's children in the form of increased poverty, higher risk of violence in the home and often deteriorating states of mental health. Suicide is now the leading cause of death for children ages 10 to 14. Now if that doesn't shake our nation to the core I don't know what will. Our hospitals were overwhelmed last year, first of all, with adolescents, severe psychosis, depression, eating disorder, all of those caused by really essentially being home and being away from their routine. And we thought the younger kids might not be so affected, but we're actually now seeing developmental delays. We're seeing poor school performance,

poor attention, and then we can't ignore anxiety. So kids pick up on anxiety. And that idea that they might be the ones to get COVID and worse to bring home COVID to potentially grandparents or fragile parents. There are a lot of kids living with a lot of anxiety. And I just wanted to ask you about, I guess, the risks that this age group faces in Canada. I mean, in BC, we saw this over and over again, this narrative that children in school were at a low risk. But we know that children under 12 now account for the highest number of COVID-19 infections in Canada. The chief public health officer, Dr. Teresa Tam, said those under 12 currently represent over 20% of daily cases,

despite only representing 12% of the country's population. Can you put those numbers in perspective for me? Absolutely. So, and you mentioned, it's very important that yes, kids in this age group are not severely sick from COVID. So even though they're representing across country anywhere from 20 to 40% of new cases, this is a huge number. They're not that many in hospital. And so there's not a surge of COVID cases in hospital. And so they are being infected. And there are many more being infected than we actually test positive. And so that's important to realize. So kids are not overwhelming the hospital system. But in that number of kids that's getting infected, there are some that get severely

sick. And there are some that are getting this post COVID inflammatory syndrome, where we're promoting this vaccine, because some kids are getting sick, and the more kids we have, the more at risk for these severe outcomes. Tell me more about that. What is post-COVID inflammatory syndrome? Yeah, this is a great question because even just last week I had a case and the parents aren't always aware of what this is. So these are kids who've had COVID and sometimes it's mild, sometimes asymptomatic. And about four to six weeks after their COVID infection, they start having these really, really high fevers. And these fevers tend to last for a few days.

And then they have a lot of symptoms, for example, rash and just feeling really unwell. And by the time they come to hospital, they can go into severe shock to the point where they need to go into the ICU because of such severe inflammation in their body. So it's inflammation in the blood and in the heart. And thankfully, we haven't had any deaths from this here in Canada. But we've had a large number of kids go to the heart. And thankfully, we haven't had any deaths from this here in Canada. But we've had a large number of kids go to the ICU. My case last week, you know, really, really severe. And just quickly, how common is this? How common is post COVID inflammatory syndrome?

So we're trying to put the numbers together where it's not very common. So it's still rare. We're estimating in Canada, we're about six in 100,000. So we've had about three to 400 cases since the start of the pandemic. So it's a rare complication, but it can be a severe one. And in other countries, they've seen what we call long term heart effects where there's aneurysms in the heart. And there have been some deaths overseas from this syndrome. So let's talk about the vaccine itself. What vaccine will kids be getting? And how is it different than the regular Pfizer vaccine? So it is going to be the Pfizer vaccine. The Moderna one is still under study, so that might come out later. But right now it's the Pfizer. And so it's the exact same component. It's this mRNA vaccine, which the body uses to make proteins, the spike protein against the COVID virus. Now, the difference, the key differences are the dose.

So the adult dose is 30 micrograms. The kid's dose is 10 micrograms, which is a third of the dose. And there's a difference in the buffer, the liquid that we use to keep it stable. The buffer we're using is called Tris instead of PBS. And it's a technical thing, but it's something that we've always been using in vaccines. So it's nothing new that's been created. And then the actual amount

that's going to go into the child is different. So the vials are different. It's an orange top versus a purple top from adults. And it's going to be 0.2 ml. So a very small volume that's going to go in. So I guess one thing that parents might have concerns or questions about is that while this is a different dosage than the adult dose, the same dosage will be given to kids ages five to a kid that's almost 12 years old. What's the rationale for this being a cohesive age group that will all get the same dosage? So it's important to realize that vaccines are different from medications and antibiotics, for example. So when we're giving an antibiotic,

we want a specific dose that's going to have an amount in the blood. So when we're giving an antibiotic, we want a specific dose that's going to have an amount in the blood. So we do dose it per kilo. So it's in milligrams per kilo of child. With vaccines, what we're looking for is just the minimum amount of antigen exposure that's going to trigger the immune system. And so what we do is we dose vaccine based on the child's developmental age and essentially the immunological maturity of the child. And so that age range from 5 to 12 is really very uniform as far as how their immune systems respond. So we don't need to dose it according to the weight of the child.

It's really the child's developmental progression as far as their immune progression. And that's pretty constant between that 5 to 12 age group. Once we hit puberty, there's a lot of hormonal changes and gradually your immune system starts to slow down. You just mentioned testing and I'm curious about that, about the trials that this pediatric vaccine in particular, I'm curious about how many kids got the shot, shot who got the shot and what did we see can you can you walk me through one of those trials or how this worked for the testing for this age group absolutely so it's actually really it's a very interesting story and if parents want to know

more the nasty statement really has a great description of the clinical trial so in the first phase they looked at trying to find the right dose. So they actually gave four kids the 30 microgram dosing, and they realized that the reaction was so strong, they had really side effects, fever, chills. So there was an internal review committee that said, let's go down to the lower dose based on this reaction. And so then they studied this lower dose in about 300 kids. And they were able to measure that these 300 kids had an appropriate immune response. So the level of antibodies that was equivalent to the higher dose. And then they went ahead and studied it in a larger group of kids. So essentially about 3000 kids across sites, mostly in the US got this vaccine. And then there were about 1500 who

didn't get any who were called the controls. And what they did is they looked at COVID cases among those who were vaccinated and those who were in the control group. And there was about a 90%, 91% effectiveness against getting COVID among those who had the vaccine. In the Dragon's Den, a simple pitch can lead to a life-changing connection. Watch new episodes of Dragon's Den free on CBC Gem. Brought to you in part by National Angel Capital Organization. Empowering Canada's entrepreneurs through angel investment and industry connections. Hi, it's Ramit Sethi here. You may have seen my money show on Netflix. I've been talking about money for 20 years.

I've talked to millions of people, and I have some startling numbers to share with you. Did you know that of the people I speak to, 50% of them do not know their own household income. That's not a typo. 50%. That's because money is confusing. In my new book and podcast, Money for Couples, I help you and your partner create a financial vision together. To listen to this podcast, just search for Money for Cops. I want to talk about side effects. I'm curious if there are any side effects of the vaccine that may be different from the vaccine side effects for adults. So in general, kids do have a stronger immune response,

but I think with the lower dose, they're going to have less of that. So the immediate response will be similar to adults, the sore arm, a little bit of pain, a little bit of red. So the immediate response will be similar to adults, the sore arm, a little bit of pain, a little bit of redness at the injection site. What's interesting is the systemic effects. So the fevers, the chills, the feeling like you've been run over by a truck, those have been less frequent in kids than in adults. And then the one side effect that we're looking out for that was seen in adolescent and young adults, mostly males, is the risk of myocarditis, inflammation of the heart. Again, a rare risk, but it was seen in these older adolescents and young adults. And so far, there have been no cases described in kids,

but that's one of the side effects we're potentially watching out for. Can you tell me a little bit more about that? What could happen if you get this condition? So myocarditis is inflammation around the heart. And the way it usually presents is chest pain, what we call palpitations. So like a fluttering feeling in your heart, and maybe shortness of breath, generally not fever, not chill. So it's really just an abnormal tightening of the chest. And it's very rare, we're estimating it about three in 100,000 in that older age group. And it's really been seen in males. Now we've had a few cases of myocarditis here in Canada. But in general, and really the

cases we've had either got better without any treatment or got better with mild anti inflammatory treatment. We haven't had cases in youth that have needed intensive care or intensive treatment, and all of them have recovered. So it's really, it's a temporary inflammation around the heart. I remember there was a young male hockey player who got this condition as well, but it was from COVID-19 rather than the vaccine. That happens as well, right? Archie, when he came across from the States, had to quarantine for 14 days. Coming out of his quarantine, he tried to skate for a few days and just wasn't feeling right.

So we got a bunch of tests done with him. And what the test showed is at some point this summer, he'd had COVID. Since then, he's been diagnosed with myocarditis. So the doctors are taking care of him. He's getting a bunch more tests done, but ultimately he's out indefinitely right now. Absolutely. And actually, it's more common to get myocarditis from having COVID or sometimes that post-COVID syndrome than it is from the vaccine. If you get COVID, there is, especially in young adults and in young children, there is a

risk of myocarditis. And so it is something that can be severe with COVID and the risk is actually greater from COVID than it is from the vaccine. So Health Canada has approved a minimum of three weeks between the two shots. NACI has suggested kids wait eight weeks between the first shot and the second. What are the reasons for those different timelines? Yeah, and this is a great question. And a lot of people have been asking me this. I think it's important to realize what the different rules are of NACI and Health Canada. So Health Canada approves a drug based on how the

company submits it. So the Pfizer trial data was 21 days. And so their job is to approve it based on all the data they have from the company. NACI is an advisory committee. And so they look not just at the company's data, but they look at other studies, other cohorts, they look at their previous experience with vaccinations, and they come up with an interval and a recommendation based on other experiences as well. And so the reason to delay the interval is really for two reasons. It's based on our experience with other vaccines. We know that in general, the longer the interval between doses, the longer and the stronger your immune response is. the longer and the stronger your immune response is. And we've seen that, for example, on the adult vaccine rollout, where we delayed the interval in some provinces, and we've had a much

more robust immune response. So that's the first reason is that really based on vaccine history, principles of immunology, the delayed interval in general is better for vaccine durability. And the next reason is really to minimize side effects. So there is some Canadian data that NACI and the different provincial committees have that have looked at this risk of myocarditis with a delayed interval. So instead of the three-week interval using the eight, 12-week interval. And there is data showing a decreased risk of myocarditis with this delayed interval. So for these reasons, to increase the effectiveness of the vaccine response and to minimize side effects,

they've chosen the eight-week interval. Now, some of this data is not published. And if you do look at the NACI guideline, and for example, even the Quebec Immunization Committee, there are references for this interval. And this is actually based on our real-world experience here in Canada. for this interval. And this is actually based on our real world experience here in Canada. For example, in Quebec, a delayed interval was chosen from the onset for adult first doses. And so they have their local surveillance data. And so they look at the efficacy. So how well we've protected against acute COVID. And then there's some data on immune response. And so just looking at real world data, for example, when you compare immunity here in North America, in Quebec, or in places where we've had this delayed interval, versus places like Israel, where they had a very strict 21 day interval, we saw waning immunity

much quicker in the Israeli population than we've seen, for example, here. I want to talk about some of the the structural issues or about how the vaccine for this age group is going to be rolled out. I know in Quebec there's this is going to be happening through the school system. Appointments are already open on the province's booking platform Clixante. Vaccination in schools will begin next week on November 29th. What do you think of the the vaccine for this age group being rolled out within the school system? So I think it's a great idea. I think we need a hybrid model because some kids really do want their parents, especially the five, six-year-olds,

really do want their parents with them. And so using the vaccination centers that we have for adults and just modifying them as we've done for kids. I think it's a great option to have, but it's not enough because it's not easy for all parents to take the time off work to really, there's a lot of logistics around organizing to get a child to the vaccine center. And we saw with the vaccine rollout for the 12 to 16 year olds, I saw with my own patients, it's not always easy to make those appointments, to navigate the online system and to get that time. And so having it in schools where children are where we've been used to giving vaccines, for example, hepatitis A and HPV, there is an infrastructure and it really allows for more equitable vaccine distribution. So we're ensuring that kids from all neighborhoods

essentially have access to this vaccine. And speaking of access and equity, we've covered this on the show before. There's been a lot of debate over whether our government should even be giving Canadian kids these vaccines, not from a safety standpoint, but from an equity standpoint. And I'll ask you what parents should do with that knowledge in a second. And I'll ask you what parents should do with that knowledge in a second. But first, can you refresh listeners on how we are doing globally in terms of getting the vaccine out there? I'm glad you asked that because the truth is it's not good. For every three doses given in our setting, there's maybe one dose given to a low and middle income country. So at this point, there are health care workers, vulnerable people in low and middle income countries who So at this point, there are healthcare workers, vulnerable

people in low and middle income countries who've had no access to the vaccine. And it is a problem because, and I think most people understand this, this pandemic will not be over until it's over everywhere. And with all of that in mind, what is the most ethical thing for us to do in this really sort of messed up global situation? You know, and I've really thought about this a lot, because again, I have so many friends and colleagues all over the world who are struggling to get their first doses. What I think it's important to realize is that the decision has been made and those pediatric, those vaccines are here in Canada right now. There are 2.9 million doses that are here. And so it does no one any good to waste these vaccines.

And I think if we reframe it, you know, Canada is in such a unique position. We have the privilege of having the vaccine. We have very good, not 100%, we have very good vaccination coverage. So if we do pull together as a society and we get our kids vaccinated, our adults are vaccinated, we could be a model for other places as to how we can successfully get out of a pandemic. So I really think the best thing we can do is really not waste this privilege, this incredible opportunity that we have, and to not let those doses go to waste. Fatima, thank you so much for this.

And also just for all your work in keeping the public informed throughout this pandemic. Really, really appreciate all everything you've done. Well, thank you so much for letting me talk to all of you today. Before we go today, we talked recently on the show about the extreme weather that has pummeled parts of Western Canada. Well, this week, already reeling from record-breaking rain and devastating floods, Atlantic Canada was hit by its own atmospheric river. Atlantic Canada was hit by its own atmospheric river. Torrential rains washed out roads in Nova Scotia and Newfoundland, including parts of the Trans-Canada Highway. Oh, that's a lot of rain. We ain't seen that here before.

Now I know, right? Emergency crews were dispatched to fix roads and bridges and reconnect communities that had been cut off because of the storms. Officials say it could take days, if not weeks, to get things back to normal. That's all for this week. And hey, if you like the shows this week, please give us a rating and leave a review on your podcast app. It really helps other people find us online. Frontburner is brought to you by CBC News and CBC Podcasts. The show was produced

this week by Simi Bassi, Imogen Burchard, Ali Janes, Katie Toth, and Derek van der Wijk. Our sound design was by Mackenzie Cameron and Nuruddin Korane. Our music is by Joseph Chabison of Boombox Sound. Special thanks to Andrew Criarda, Kate Partridge, and the team at CBCBC for your support this week. The executive producer of Frontburner is Nick McKay-Blokos. I'm Angela Starrett, filling in for Jamie Poisson,

and I'll talk to you again soon.