Q: Which COVID-19 vaccine should I recommend to my patients?
A: COVID-19 vaccines are life-saving vaccines. Delaying immunization leaves an individual vulnerable to infection for a longer period of time, placing them at greater risk of serious illness and death. AAP recommends COVID-19 vaccination for all children and adolescents 5 years of age and older who do not have contraindications using a COVID-19 vaccine approved through an Emergency Use Authorization (EUA) or Biologics License Application (BLA), recommended by CDC, and appropriate for their age and health status. AAP also supports coadministration of COVID-19 vaccines with other vaccines on the immunization schedule. See AAP policy.
Research trials have shown COVID-19 vaccines are highly effective against severe COVID-19 illness, hospitalization, and death. Those who are 5-17 years old should receive the Pfizer-BioNTech vaccine; while those 18 years of age or older may receive what is recommended and available in their community, with a preference for mRNA vaccine (ie. Pfizer-BioNTech or Moderna).
Q: What do we know about the new SARS-CoV-2 variants and vaccine efficacy?
A: Multiple variants of SARS-CoV-2 have been documented in the United States and globally during this pandemic. Data show that vaccines may be less effective against Omicron variant in preventing infection and that effectiveness may diminish over time; however, they are still effective in preventing hospitalization and death. The AAP continues to support COVID vaccination among the population as it is the best way to prevent severe morbidity and mortality from SARS-CoV-2. A report published in the New England Journal of Medicine in March 2022 provides updated information about vaccine effectiveness in children and adolescents during the Delta-predominant and Omicron-predominant periods. Expert analysis of this article can be found in the March 31 AAP COVID-19 Town Hall recording at 10:44.
During Omicron variant predominance beginning in late December 2021, U.S. infants and children aged 0–4 years were hospitalized at approximately five times the rate of the previous peak during Delta variant predominance. Further, COVID-19–associated hospitalization rates in children aged 5–11 years were approximately twice as high among unvaccinated as among vaccinated children. Thus, important strategies should be utilized to prevent COVID-19 among infants and children, including vaccination of currently eligible populations such as children 5 years of age and older, pregnant women, family members, and caregivers of infants and young children.
New COVID-19 Variants | CDC
Q: Which COVID-19 vaccines have been approved and/or authorized for use in the US?
A: The US has two mRNA and one viral vector COVID-19 vaccines for use in response to the pandemic. The CDC has recommended COVID-19 vaccines with a preference for people to receive an mRNA vaccine (Pfizer-BioNTech and Moderna). Janssen vaccine is available for individuals who are unable or unwilling to receive an mRNA vaccine.
Pfizer-BioNTech mRNA Vaccine
Moderna mRNA Vaccine
Janssen (J&J) Viral Vector Vaccine
As we near the anticipated approval of vaccine for children ages 6 months to 4 years, consider reviewing the CDC Pediatric COVID-19 Operational Planning Guide which can be accessed here.
Q: Which Pfizer-BioNTech vaccine dose should a child receive if they are 11 years of age, but will turn 12 years old before they can receive a second dose?
A: The CDC recommends providing children with the dose that is recommended for their age at the time of vaccine administration. For example, an 11 year old child should receive 10 mcg - the pediatric formulation for children ages 5-11 (orange cap). If this child turns 12 prior to returning for their second dose 21 days later, they should receive 30 mcg - the original formulation (grey or purple cap) for adolescents age 12 and older.
If a child turns from 11 to 12 years of age in between their first and second dose and receives the pediatric formulation for their second dose, they do not need to repeat the dose.
Q: What are the vaccine recommendations for children and adolescents who are moderately to severely immunocompromised?
A: Pediatricians who care for children and adolescents with certain immunocompromising medical conditions or who are receiving treatments that induce moderate to severe immune suppression should encourage their patients to be vaccinated with a 3-dose primary series of mRNA vaccine; the Pfizer-BioNTech vaccine for 5-17 year olds and either the Pfizer-BioNTech vaccine or Moderna vaccine for those 18 years of age and older (see CDC Clinical Considerations for a list of conditions). The recommended interval between dose 1 and dose 2 is 21 days for Pfizer-BioNTech and 28 days for Moderna. The recommended interval between dose 2 and dose 3 is at least 4 weeks after the 2nd dose for either vaccine product. It is recommended that the same mRNA vaccine product be used for all doses in the primary series.
Patients who are 5 years of age and older should also receive a booster dose 3 months after their 3rd dose. While any product may be used for those 18 years of age and older, there is a preference for mRNA vaccine. Patients 12 years of age and older are also allowed to receive a second booster dose (must be an mRNA vaccine) 4 months after their first booster dose. Prior to and following COVID-19 vaccine administration, infection prevention measures should continue such as wearing a mask, physical distancing, and avoiding crowds and poorly ventilated indoor spaces, as immunocompromised individuals may still be at increased risk for COVID-19. Close contacts of immunocompromised individuals who are eligible should receive COVID-19 vaccination to provide additional protection.
Information on immunization and immunocompromised children and adolescents can be found in the:
Red Book: Immunization and Other Considerations in Immunocompromised Children | Red Book® 2021 | Red Book Online | AAP Point-of-Care-Solutions
CDC Clinical Considerations: https://www.cdc.gov/vaccines/covid-19/clinical-considerations/covid-19-vaccines-us.html
Talking with Patients Who Are Immunocompromised: https://www.cdc.gov/vaccines/covid-19/clinical-considerations/immunocompromised-patients.html
Q: Should patients receive a booster dose of COVID-19 vaccine?
A: Yes. The protection COVID-19 vaccines provide decreases over time, especially for certain groups of people. CDC recommends the use of a single booster dose for all individuals 5 years of age and older. Those who received the Pfizer-BioNTech COVID-19 or Moderna vaccine as their primary series should receive a booster dose at least five months after completion of their 2-dose primary series. Those who received the Janssen (J&J) COVID-19 vaccine should receive a booster dose 2 months following their initial dose. Any EUA authorized and approved COVID vaccine can be used for the single dose booster for individuals 18 years of age and older, however, there is preference for people to receive an mRNA vaccine (ie Pfizer-BioNTech 30 mcg or Moderna 50 mcg). Janssen (J&J) 0.5 ml can be used for individuals who are unable or unwilling to receive an mRNA vaccine booster.
Individuals who are 12-17 years of age should receive a single booster dose of Pfizer-BioNTech COVID-19 Vaccine (COMIRNATY) 30 mcg at least 5 months after the final dose in the primary series.
Individuals who are 5-11 years of age should receive a single booster dose of Pfizer-BioNTech COVID-19 Vaccine 10 mcg at least 5 months after the final dose in the primary series.
The CDC offers more information about booster doses, including eligibility and answers to frequently asked questions.
Experts continue to recommend that everyone get vaccinated and boosted, regardless of whether they’ve had COVID-19 in the past. As cases increase across the country, a booster dose will safely help restore and enhance protection against severe disease.
Q: Can I administer a COVID-19 vaccine to a patient who is currently sick with COVID-19?
A: COVID-19 vaccination should be deferred for patients with a current SARS-CoV-2 infection until they recover from their acute illness and the criteria to discontinue isolation has been met. Patients who are asymptomatic should receive COVID-19 vaccine following their recommended isolation period. This also applies to people who become infected with COVID-19 between their first and second dose of vaccine, or those who are due for a booster.
Individuals who recently had SARS-CoV-2 infection and have concluded their isolation period may consider delaying a primary series dose or their first or second COVID-19 vaccine booster dose by 3 months from symptom onset or positive test (if infection was asymptomatic). Studies have shown that increased time between infection and vaccination may result in an improved immune response to vaccination.
Q: What is the difference between COVID-19 mRNA and viral vector vaccines?
A: Messenger RNA (mRNA) Vaccines
These vaccines use a newer technology where mRNA is wrapped in a coating (lipid nanoparticle) so it can enter our cells. The mRNA in the vaccine teaches our cells how to make copies of a spike protein. Once the spike protein is made, two things occur: (1) the cell breaks down the mRNA (instructions) and gets rid of them, and (2) the spike protein triggers an immune response inside of our bodies, which produces antibodies. These antibodies protect us from getting infected if the real virus enters our bodies.
Viral Vector Vaccines
Viral vector vaccines use a modified, harmless version of a different virus to deliver instructions to our cells. The virus enters the cell and teaches it how to make copies of a spike protein, which then triggers an immune response inside of our bodies. This immune response results in the production of antibodies which protect us from getting infected if the real virus enters our bodies.