COVID-19 and My Child

How might COVID-19 affect my child?
In general, studies show that children with sickle cell disease (SCD) and COVID-19 have mild symptoms and a low risk of death. However, research has shown that children with SCD-related comorbidities (such as a history of frequent pain crises and lung, heart, and kidney dysfunction) may be at increased risk of severe COVID-19 illness compared to children without SCD.

Compared to adults with or without SCD, children with SCD are less likely to experience severe illness and death related to COVID-19.

There is also evidence to suggest that patients receiving disease-modifying therapy for sickle cell disease (such as Hydroxyurea) may have better outcomes should they contract COVID-19. However, the long-term effects of COVID-19 are still unknown.

Each individual is different, so it is important to discuss with your child’s doctor about the best course of treatment for the prevention of COVID-19 and in the event your child contracts COVID-19.

Is my child old enough to receive a COVID-19 vaccine?
Health Canada has approved the COVID-19 vaccines for children over the age of 5 (see page 5). They are expected to approve COVID-19 vaccination for children between 6 months and 5 years of age in the summer of 2022. This approval has recently been made in the United States. In clinical trials, the vaccines were found to be effective, side effects were mild or moderate, and there were no safety concerns in children of this age group.

Is the vaccine safe for my child?
The COVID-19 vaccines are safe and effective, and billions of doses have been given worldwide. For both children and adults, the vaccines lower the risk of getting, spreading, and becoming seriously sick from COVID-19.

Generally, the risks associated with contracting the COVID-19 virus heavily outweigh the risks associated with vaccination. However, as with any medical treatment, consulting with your healthcare professional is best if you have specific questions about your situation.

According to Ontario.ca, “Health Canada has one of the most rigorous scientific review systems in the world and only approves a vaccine if it is safe, works, and meets the highest manufacturing and quality standards.”

Which vaccine should my child get?
The following vaccines have been approved:

• Pediatric Pfizer (10 micrograms) for children aged 5 to 11 years old
• Half dose of Moderna (50 micrograms) for children 6 to 11 years old
• Pfizer (30 micrograms) for youth aged 12 and up
• Moderna (100 micrograms) for youth aged 12 and up

Booster vaccine doses are strongly recommended for:

• 12-17-year-olds, at least 6 months after the second dose
• 18+, at least 3 months after the second dose

For people aged 6-29 years of age, Pfizer is the preferred vaccine because of lower reported rates of myocarditis or pericarditis (a rare condition causing inflammation of the heart) following vaccination, compared to Moderna. However, the Moderna vaccine may be preferable for people aged 6-17 with a weakened immune system. Consult with a health care provider for more information.

Does my child still need to be vaccinated after testing positive for COVID-19?
YES. Getting vaccinated can protect against reinfection and further spread of the virus, whether your child:

• has tested positive for COVID-19 and/or
• is symptomatic AND a household contact of a confirmed COVID-19 case

If your SCD-diagnosed child:

• has COVID-19 symptoms
• has no symptoms but has tested positive for COVID-19

 They should wait 8 weeks before receiving the vaccine. They may wait 8 weeks from when their symptoms started or when they tested positive before receiving the first or second dose of the COVID vaccine or 12 weeks for a booster dose of COVID vaccine. Your child can also get a dose of the COVID vaccine as soon as the symptoms are resolved and they have finished self-isolation.

 What if my child experiences side effects from the vaccine?
Certain vaccine side effects are normal. The most common side effects are:

• redness/swelling on the arm where the vaccine was given
• fatigue
• muscle soreness
• headache
• mild fever

These side effects should go away after a few days. If they continue for longer, visit a healthcare professional as soon as possible.

Myocarditis and Pericarditis: What are they and should I be concerned?
Myocarditis: Inflammation of the heart muscle
Pericarditis: Inflammation of the lining outside the heart

In a very small number of cases, these conditions have occurred after the second dose of vaccination. However, these cases are very rare. Myocarditis/Pericarditis has mostly occurred in young adult males aged 18-30 years old. Most cases were mild and recovery was quick.

Please note that myocarditis and pericarditis after COVID-19 vaccination are very rare. There is a greater risk of myocarditis/pericarditis after a COVID-19 infection compared to getting the COVID-19 vaccine.

Sources:
Boehmer, T. K. (2021). Association between covid-19 and myocarditis using hospital-based administrative data—the United States, march 2020–January 2021. MMWR. Morbidity and Mortality Weekly Report, 70. https://doi.org/10.15585/mmwr.mm7035e5

Canada expected to finish the review of the first COVID-19 shot for the youngest kids in weeks. (2022, June 17). CTVNews. https://www.ctvnews.ca/health/coronavirus/canada-expected-to-finish-review-of-first-covid-19-shot-for-youngest-kids-in-weeks-1.5951775

Campbell, J. I., Dubois, M. M., Savage, T. J., Hood-Pishchany, M. I., Sharma, T. S., Petty, C. R., Lamb, G. S., Nakamura, M. M., & Pediatric COVID-19 US Registry. (2022). Comorbidities associated with hospitalization and progression among adolescents with symptomatic coronavirus disease 2019. The Journal of Pediatrics, S0022-3476(22)00169-X. https://doi.org/10.1016/j.jpeds.2022.02.048

COVID-19 and Children. (n.d.). Retrieved 16 June 2022, from http://www.bccdc.ca/health-info/diseases-conditions/covid-19/covid-19-and-children

Covid-19: Vaccine eligibility & doses. (2021, December 8). The city of Toronto. https://www.toronto.ca/home/covid-19/covid-19-vaccines/covid-19-vaccine-eligibility-doses/

COVID-19: Vaccines for Children & Youth. (2021, October 20). The city of Toronto. https://www.toronto.ca/home/covid-19/covid-19-vaccines/covid-19-children-vaccines/

COVID-19 vaccines for children and youth. (n.d.-a). COVID-19 (Coronavirus) in Ontario. Retrieved 16 June 2022, from https://covid-19.ontario.ca/covid-19-vaccines-children-and-youth

COVID-19 Vaccines for Children and Youth. (n.d.-b). https://files.ontario.ca/moh-covid-19-children-youth-vaccination-factsheet-en-2021-12-23.pdf

Covid-19 vaccines for kids under 5: What parents need to know. (n.d.). Yale Medicine. Retrieved 24 June 2022, from https://www.yalemedicine.org/news/covid-19-vaccines-kids-under-5

Goldman, R. D. (2022). Myocarditis and pericarditis after COVID-19 messenger RNA vaccines. Canadian Family Physician, 68(1), 17–18. https://doi.org/10.46747/cfp.680117

Hoogenboom, W. S., Alamuri, T. T., McMahon, D. M., Balanchivadze, N., Dabak, V., Mitchell, W. B., Morrone, K. B., Manwani, D., & Duong, T. Q. (2022). Clinical outcomes of COVID-19 in patients with sickle cell disease and sickle cell trait: A critical appraisal of the literature. Blood Reviews, 53, 100911. https://doi.org/10.1016/j.blre.2021.100911

Mucalo, L., Brandow, A. M., Dasgupta, M., Mason, S. F., Simpson, P. M., Singh, A., Taylor, B. W., Woods, K. J., Yusuf, F. I., & Panepinto, J. A. (2021). Comorbidities are risk factors for hospitalization and serious COVID-19 illness in children and adults with sickle cell disease. Blood Advances, 5(13), 2717–2724. https://doi.org/10.1182/bloodadvances.2021004288

Yurtsever, N., Nandi, V., Ziemba, Y., & Shi, P. A. (2021). Prognostic factors associated with COVID-19 related severity in sickle cell disease. Blood Cells, Molecules & Diseases, 92, 102627. https://doi.org/10.1016/j.bcmd.2021.102627

Acknowledgments
Dr. Ewurabena Simpson
Children’s Hospital of Eastern Ontario

Dr. Na-Koshie Lamptey
Toronto Public Health

Public Health COVID-19 Resources
City of Toronto COVID-19 Vaccine Information:
www.toronto.ca/home/covid-19/covid-19-vaccines/

Toronto Public Health COVID-19 Hotline:
Telephone: 416-338-7600
TTY: 416-392-0658

Public Health Agency of Canada Vaccine Information:
https://www.canada.ca/en/public-health/services/diseases/coronavirus-disease-covid-19/vaccines.html

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