The COVID-19 Vaccine and Kids with Dr. Kimberly Giuliano

Podcast Transcript

Molly Shroades:

Hi, thanks for joining us for this episode of the Health Essentials podcast. My name is Molly Shroades and I'll be your host today. Today, we're talking about the newest age groups to be eligible for the COVID-19 vaccine, kids ages 12 and up. Today, we're talking with pediatrician, Dr. Kimberly Giuliano. Thank you for being here.

Dr. Kimberly Giuliano:

Thanks for having me, Molly.

Molly Shroades:

So just to get started, can you remind us a little bit about the vaccine, how it works, and which ones are available?

Dr. Kimberly Giuliano:

Yes. So, there are two different main types of vaccines available right now from three different companies. So, Pfizer and Moderna both have a vaccine that uses mRNA technology. What happens with that vaccine is you receive a small amount of mRNA that your body then uses to make a protein, and your body then further make some antibodies against that protein. The Johnson & Johnson vaccine is used a slightly different technology, where a portion of the proteins from the COVID virus are attached to another virus and that enters into your body and then your body makes antibodies to those proteins directly.

Molly Shroades:

Great. So this started out with being just adults, but we've now moved into children. Can you confirm for me which age group we're currently working on?

Dr. Kimberly Giuliano:

Yes. So the Moderna and the Johnson & Johnson vaccines are currently approved for ages 18 and up, and then the Pfizer vaccine has recently been approved down to the age of 12.

Molly Shroades:

Awesome. So, was there any difference between the vaccine that children may receive compared to what an adult has received?

Dr. Kimberly Giuliano:

So, children currently are receiving the exact same vaccine as adults. Nothing is different in terms of dose or content so far for children.

Molly Shroades:

Okay. And no additional risks for children?

Dr. Kimberly Giuliano:

There are no additional risks. Children are tolerating the Pfizer vaccine very similarly to the adults in terms of both effectiveness, as well as the safety profile.

Molly Shroades:

And speaking of that, I know for many adults there were side effects, some minor things, some more annoying things. Can you tell us a little bit about what side effects people have experienced and if that is a possible risk for children as well?

Dr. Kimberly Giuliano:

Absolutely. So first and foremost, I think it's important that we all recognize that both children and adults can have absolutely no side effects at all. That's happens. I think we hear about it just because it is a little bit more of an annoyance. And with so many people getting vaccinated, it's common that people want to share their vaccine stories with each other, right? So the most common side effects that we can see are a sore arm, muscle aches, fatigue, and low grade fevers. And those typically occur several hours within 24 hours after the vaccination. And then, the side effects are typically lasting about 24 hours or less. So mild, minor annoyances compared to the alternative with a COVID disease causing much more severe symptoms and lasting much longer.

Molly Shroades:

Absolutely. So, how would you recommend parents prepare their child for the vaccine? Is there anything like giving them Tylenol in advance that you would suggest?

Dr. Kimberly Giuliano:

So, I would not recommend giving Tylenol in advance. Tylenol does lower your antibody response. And so in order for the vaccine to be most efficacious, it's best if we don't interfere with what our body is doing. Now, that being said, if you get to the point that you're developing side effects and they're more than just a little annoying, it's completely fine to go ahead and use a medication like Tylenol to help alleviate some of those symptoms. Taking a step back, I really think the best way to prepare a child for the vaccine is to let them know what to expect. Share your own vaccine story with them. Share with them the importance of the vaccine, how it is safe, how it is effective, and how it can help us get back to what we long for in terms of those normal lives.

Molly Shroades:

Awesome. Can you just tell me a little, a few quick talking points that you would suggest parents bring up with their kids?

Dr. Kimberly Giuliano:

Yeah. So, I would suggest the parents tell their children that the vaccine is very safe. I think it's important that they hear that. Children hear a lot of the same mixed messages that we're hearing as adults, right? So if they have a friend or another family member who has had a different opinion about the vaccine, it's really important that they understand that what you're doing for them is designed to help keep them healthy and safe. So, I would start with that piece. I would also ask the child what they've heard about the vaccine, so that you understand where they're coming from. Maybe they're 100% on board and this conversation is going to be very quick and easy, right? Or maybe they have some questions and concerns. And then, diving into what their specific questions and concerns are can be really helpful. And making sure that you're making a decision that's beneficial for your child.

Molly Shroades:

Speaking of things that kids might have heard or adults might've heard about it, there are a lot of myths floating out there and common misconceptions, as well as it seems like we've moved very quickly through this process. Can you tell me a little bit about the research that has gone into this and the safety of this for our children?

Dr. Kimberly Giuliano:

Absolutely. So, the original studies were done on tens of thousands of people. And they looked to make sure that both safety and efficacy were there, right? And that's where we started with the vaccine. Pfizer originally down to the age of 16 and the other vaccines starting at age 18. And then in order to get the indication lowered from 16 to 12, Pfizer had to assemble another research study of several thousand children. So not tens of thousands of children or patient were originally involved, but they'd had to show us with many thousands of children that the results were similar both in terms of effectiveness as well in terms of side effects. So it does seem like this 12 to 15 year group got approval a lot faster and that's because they did, right?

              When we're adding onto an existing approval, we're looking at a smaller subset. And just looking to make sure that subset is responding in a similar way. And it makes scientific and medical sense too. We don't really expect that age 12 year olds immune system is going to be that different than a 16 year olds, right? So relying on some data from closely related peers, 16 year olds, 18 year olds. We can feel comfortable knowing that was all taken into account, and what helped us to get the indication for the 12 to 15 year olds a little bit faster than what it took us to get it for the adults.

Molly Shroades:

So speaking of some of the myths that people might have also heard of, for example, long-term effects of the vaccine like infertility. Can you kind of help us debunk those a little bit and explain to people why that is or isn't a concern?

Dr. Kimberly Giuliano:

Yeah. So, there is no problems reported with fertility. And while I understand why perhaps some people came up with that thought and theory, when you really understand the science behind the vaccine, we can understand why that's not necessarily the case, right? So I think people hear mRNA and think of it as a genetic device, right? And genes are part of our reproduction and similar to DNA. And perhaps that's where some of the questions and concerns came into play, right? What I think is important to know is that mRNA is different than DNA, mRNA cannot get into the nucleus of your cells. And that's where the genetics live and breathe and stay, right?

              So, it's scientifically impossible for mRNA to get in there. I'm very comfortable with that. And then, we can all be further reassured that after the mRNA has coded for that protein in your body, your body gets rid of the mRNA. You don't have mRNA floating around in your body forever. So in terms of long-term effects, we assume that this is going to be very safe and similar to our other vaccines, because really what staying with our body is the antibodies that protect us from disease and not these other pieces.

Molly Shroades:

And actually piggybacking off of the other vaccines, I was wondering, how does this interact with the vaccine schedule that children get normally? I know those are often grouped together by age group. Do you need to pick a specific time kind of to be grouped in there in that schedule or can the COVID vaccine be given as soon as it's available?

Dr. Kimberly Giuliano:

The COVID vaccine can be given as soon as it's available. It can be given at the same time as routine childhood vaccines. And if you got other childhood vaccines a couple of days ago, you can get the COVID vaccine today. Similarly, if you get the COVID vaccine today, you can get other vaccines within several days of it. There's no minimum intervals between routine vaccinations and the COVID vaccine.

Molly Shroades:

Is it correct that children generally get a more mild version of COVID? And, why is it still important to get them vaccinated?

Dr. Kimberly Giuliano:

So, children fortunately do typically get a much milder version of COVID. It's still important that they get vaccinated because typical is not necessarily everybody. And so we do have some children who get much more significant infections, have much more severe symptoms and wind up hospitalized. There's probably been over 15,000 children who have been hospitalized since the start of the pandemic related to COVID. There's an also a syndrome associated with COVID called MIS-C or Multisystem Inflammatory Syndrome of Childhood. And that is a post-COVID illness where the immune system goes into overdrive and multiple organs are infected. Children with MIS-C are hospitalized and most of them end up in the intensive care unit. So while this disease can be mild for some children like a common cold, it's really those more severe cases that it's important that we help to protect children so that they don't end up with some more significant medical problems and consequences down the road.

Molly Shroades:

Now, can you talk to us a little bit about the safety of unvaccinated children around people who are fully vaccinated, and especially as we're moving into the mask mandates being lifted in public spaces quite often.

Dr. Kimberly Giuliano:

So, the vaccine is very effective. And I think we need to have a healthy respect that it's not 100% effective, right? So the initial trials are showing us really high efficacy rates, but not 100% efficacy rates in adults. So, it is possible. We have seen a handful of breakthrough cases of COVID in vaccinated individuals. And so if an unvaccinated individual is around that vaccinated individual who is unfortunate enough to become sick with COVID, then they can pass that onto an unvaccinated child. Similarly, an unvaccinated child could be carrying COVID themselves and spread it potentially to a vaccinated individual if that vaccinated individual is somebody who is ultimately susceptible to the disease still.

Molly Shroades:

So speaking of masks, as we are seeing a lift in the mandates of masking in public places, is there any fear or higher risk for younger children being exposed to the disease?

Dr. Kimberly Giuliano:

So, our health mandates are being lifted because the disease rates are going down pretty significantly right now. And this is good news, right? So yes, anybody who's unvaccinated is at higher risk of contracting the disease than somebody who is vaccinated. Although fortunately, if our numbers are going down, the chance of being exposed at least through the summer months are much lower, right? What we don't know about longer term is what this virus is going to do in the fall and the winter. I think that a lot of us are under the assumption that we may start to see waves again in the fall and winter months similar to what we see with other cold viruses, influenza, and those types of illnesses.

              And certainly that was the pattern that we saw with COVID throughout this past year. We had a spike in the fall, and we had a spike again in December, and then towards the end of the winter and early spring time patterns. So hopefully with the health mandates being released over the summer, children are able to socialize and interact outdoors more so than indoors. And then hopefully, we have some more vaccine options in the fall and winter months for children when we're more concerned about the rates going back up again.

Molly Shroades:

Right. So if you're a parent and you have any doubt about your child possibly being exposed to COVID, you should still reach out to your provider.

Dr. Kimberly Giuliano:

Absolutely. Pediatricians and family medicine providers are more than willing to talk to you about the specific health needs of your child and your family. And any lingering questions, you should always go to a trusted medical professional. We're more than happy to help you sort through the science, the myths, what you're hearing from family and friends, what you're reading on the internet, and really figure out what the best decision is for you and your child.

Molly Shroades:

Awesome. So for parents and teens that are interested in getting the COVID vaccine, what are their next steps?

Dr. Kimberly Giuliano:

So through the Cleveland Clinic, people are able to register online. You can go in and click on an appointment slot and register that way or through your child's MyChart account. You also can certainly reach out to retail pharmacies, your local health department. They all have slightly different ways to get scheduled, but most all free one has an online option available to you. In the state of Ohio, you can search on ODH's website, I get the shot, and that will help you find locations in your geographical area that are offering the vaccine.

Molly Shroades:

Now, do you know is there any progress on when the next youngest age group will be able to have the vaccine and what age group that might be?

Dr. Kimberly Giuliano:

Yeah. So, the drug companies currently have trials underway all the way down to six months of age. What I would anticipate is that probably in the fall, we will see an option to vaccinate other school aged children. So probably, the age group of five to 11. And then, hopefully seeing vaccines available for preschool and infants shortly thereafter.

Molly Shroades:

Wonderful. Now, I know we touched on symptoms earlier, but should you plan on your child having the day off school the next day after the vaccine?

Dr. Kimberly Giuliano:

So, I'm an optimist. I would like to think that my children would be able to go to school. And really, if you stop to think about it, I mentioned previously, there are people who have absolutely no side effects at all, so we probably don't want kids staying home with absolutely no side effects. Unfortunately, most kids have mild side effects, right? So if they're a little bit fatigued and their arm is sore and achy, I think kids can go to school. Parents are pretty attuned to knowing what types of symptoms warrant staying home from school and what types of symptoms don't. As certainly somebody who's running a fever, feeling really low on energy, and has significant muscle aches, that absolutely I think it's warranted for kids to stay home probably for one day in those situations. But you can certainly talk to your child and/or notify their school so that if symptoms start to increase as the day goes on, being able to bring that child home so that they can rest.

Molly Shroades:

So, can you give us a few tips on how to have that conversation with your children about vaccines and getting vaccinated?

Dr. Kimberly Giuliano:

Whether it's the COVID vaccine or any other vaccine, it's really important that kids understand why we're giving them the vaccine. We're not giving them the vaccine to be mean. We're not giving the vaccine because we want a poke or an ouch, right? We're giving the vaccine to prevent a disease. A disease that is far worse than the actual injection or the side effects that can come from the vaccine. And so, I think it's important that kids know that. I often use the explanation for any vaccine that the disease is typically worse. The disease typically lasts longer.

              And we don't want a child being set up for the problems that come from the disease and the side effects of the disease. We think that the vaccines are safe and that any side effect that you have with the vaccine is much better than the alternative disease. And it's important that kids understand that, especially if you're talking to an older child between the ages of 12 and 18 related to the COVID vaccine. Helping them to understand that, yes, while there maybe some potential for some mild side effects out there, the disease is way worse.

Molly Shroades:

As we wrap up, if you could just remind our listeners why getting vaccinated is so important in your child's health.

Dr. Kimberly Giuliano:

Getting your child vaccinated is the best way to protect your individual child's health. It will allow them to get back to school, get back to the activities that they enjoy doing, both indoors and outdoors with masks and without masks. So whatever you and your child want that to be able to do, this is the best way to be able to do that. It's also a great way to keep family members healthy and safe as well. Even the family members have been vaccinated, no vaccine is 100% effective. So we do still have small risks, the vaccinated individuals becoming ill. So vaccinating everybody around them really helps to prevent and reduce the risk that we're spreading it to each other. So the more people that we get vaccinated, the faster we get on with what we want to be doing, both for ourselves, our family, and our greater society at large.

Molly Shroades:

Thank you so much for talking to us today and sharing your insights, Dr. Giuliano.

Dr. Kimberly Giuliano:

You're welcome, Molly. Thanks for having me.

Molly Shroades:

To learn more about the COVID-19 vaccination, visit clevelandclinic.org/covidvaccine.