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Article:   https://www.wsj.com/articles/covid-vaccines-safe-kids-parents-11620405004?mod=saved_content

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The Centers for Disease Control and Prevention and most public-health experts recommend that eligible children be vaccinated against the virus that causes Covid-19.

Although most children who come down with Covid-19 have mild symptoms or no symptoms at all, a subset of children can get very ill, leading to hospitalization or even death, and some might have lingering symptoms long after they have cleared the virus. A small percentage of children also might experience multisystem inflammatory syndrome, or MIS-C, a rare condition that can occur in children several weeks after Covid-19 infection. Without diagnosis and treatment, this condition can lead to organ damage or even death. Infected children can also pass the virus on to others, including those who are at risk of severe disease, such as the elderly or immunocompromised.

Here is what parents should know about Covid-19 vaccines and children.

Which children are eligible to get a Covid-19 vaccine?

In the U.S., children age 5 and older are eligible to be vaccinated only with Pfizer Inc.'s and BioNTech SE's Covid-19 vaccine. The Food and Drug Administration is considering whether to authorize the Pfizer-BioNTech shots for children under the age of 5.

The vaccines from Moderna Inc. and Johnson & Johnson are currently only authorized for use in people 18 years or over.

What if my child is under 5 years of age?

The FDA said it needs more time to decide whether to authorize the Pfizer-BioNTech vaccine for children ages 6 months to under 5 years.

The agency was initially considering a request by the companies to clear the use of two doses of the vaccine before looking at expanding the authorization to a third dose. It recently announced it was looking at data evaluating a third dose of the vaccine, rather than just two.

Pfizer-BioNTech's two-dose regimen produced disappointing results in some children during testing. In children between 2 and 5 years old, the two shots didn't provide the kind of immune response researchers say is needed to protect against symptomatic Covid-19.

Researchers did see that desired immune response in children 6 months to 2 years. The response, a measure of antibody levels following vaccination, was comparable to that of people age 16 to 25 years.

How effective are the Covid-19 shots at preventing infection and illness in children?

For kids ages 5 to 11, Pfizer and its partner BioNTech released data in the fall showing the vaccine was 90.7% effective at preventing symptomatic Covid-19. The companies also said the vaccine was safe during the testing.

For 12-to-18-year-olds, the vaccine was shown to be 93% effective against hospitalization with Covid-19, CDC researchers reported in the fall.

A study published by the CDC in March showed that two doses of the Pfizer-BioNTech vaccine were protective against Covid-19-related emergency department and urgent care visits among children and adolescents.

"The vaccine is very effective at protecting against serious disease, hospitalization and death," said Tina Tan, a pediatric-infectious-disease physician at Ann & Robert H. Lurie Children's Hospital of Chicago.

Do kids get the same vaccine dose as adults?

Children between the ages of 5 and 11 get two shots of the Pfizer-BioNTech vaccine, 10 micrograms per shot, spaced three weeks apart. Those who are 12 and older also receive a two-dose regimen, though it is 30 micrograms per shot-the same dosage as adults.

My child will turn 12 years old soon. Should I wait to get the larger, 30-microgram dose for my child?

Most pediatric and infectious-diseases experts say no.

A lower dose doesn't necessarily render the vaccine less effective, they say. The Covid-19 vaccine was safe and elicited robust neutralizing antibody responses in a mid- to late-stage trial of children ages 5 to 11, according to Pfizer. The antibody responses in participants who got 10-microgram doses were comparable to those in a previous Pfizer-BioNTech study of people ages 16 to 25 who got the larger, 30-microgram doses.

If a child's 12th birthday falls between doses, the CDC says children should get the vaccine dosage based on their age on the day of vaccination of that particular dose. For instance, if a child turns 12 between doses, they should receive the larger, 30-microgram formulation for their second dose.

Does my vaccinated child need a booster shot?

The CDC recommends that people ages 12 years and older get a booster shot, while children ages 5 to 11 can currently only get a third dose of the vaccine if they are immunocompromised. If your child is under 18, they may only get a Pfizer-BioNTech booster, as the Moderna shots aren't authorized for people younger than 18 years of age.

One study published by the CDC showed that although vaccine effectiveness was lower during the Omicron wave and decreased with time since vaccination, a booster dose helped to restore that effectiveness among 16- and 17-year-olds.

What if my child has already had Covid-19? Should they still get the vaccine?

The CDC recommends vaccination even in those who have already had Covid-19. Research has shown that people who are vaccinated and have been infected are better protected than those who have only been infected.

"Anyone who has had the disease should still be vaccinated because it will give you better antibody titers," said Dr. Tan.

Can kids safely get other vaccines the same day as they get the Covid-19 vaccine?

Yes, the Covid-19 vaccine can be given on the same day and time as other vaccines, including flu and other routine vaccines, according to the CDC. If multiple vaccines are given at a single visit, each shot will be given in a different injection site. For example, one might be administered in the right arm and the second in the left arm.

Does the vaccine pose any risks to children?

Any vaccine comes with the risk of an adverse reaction, and the Covid-19 shots are no different, doctors and vaccine experts say. So far, however, researchers haven't found evidence the vaccines pose any additional or different risks to children versus adults. The most common side effects from the vaccine, according to the CDC, are flulike symptoms such as fever, muscle aches and chills. Many recipients also experience arm soreness or bruising after receiving the shot.

Experts advising the CDC have said there appears to be an association between the mRNA vaccines and an inflammatory heart condition called myocarditis in some younger people, including young adults, though the reports are rare. The CDC and other health authorities still recommend Covid-19 vaccination for those 12 and older, given the greater risk from Covid-19, which itself can cause myocarditis and other complications.

"The potential myocarditis associated with the vaccine is a very, very rare complication," said Dr. Tan. "Children who get Covid are at a much higher risk of potentially developing myocarditis than a child who is vaccinated."

The FDA flagged the risk of heart-inflammation conditions such as myocarditis in children ages 5 to 11 when it reviewed Pfizer-BioNTech data, but said the overall benefits in preventing Covid-19 disease and hospitalizations would outweigh the risk of the heart conditions. No cases of myocarditis were found in the key study testing the Pfizer-BioNTech vaccine in 5- to 11-year-olds.

In extremely rare cases, people who have received a Covid-19 vaccine have experienced severe allergic reactions, including anaphylaxis related to chemicals that help package the main ingredient in the Pfizer-BioNTech and Moderna vaccines.