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Ask An Expert: Dr. Priya Bui, UNT Health Science Center

Dr. Priya Bui, UNT Health Science Center

UNT System HR brings you UNT World experts with this periodic and always timely installation called "Ask An Expert." So, let's ask...

EXPERT: UNT Health Science Center's Dr. Priya Bui is the interim chair of the Department of Pediatrics and Women’s Health and a graduate of the Texas College of Osteopathic Medicine. With the department since 2014 and the Clinical Chief of Pediatrics since 2017, her clinical practice cares for newborns to teenagers. So, she knows a thing or two about medical care for children. Which makes her the perfect expert to discuss the now-available Pfizer COVID-19 vaccine for children ages 5-11. If you have kids in this age range, will you get them vaccinated? Do you have reservations? Feel you need to be better educated? Dr. Bui discusses topics like the risk COVID-19 poses to children, potential side effects and long-term effects of the vaccine vs. the protection provided by the vaccine, where to find vaccine research and the overall public health benefit of getting eligible children vaccinated. 

 

Q: Throughout the pandemic, an opinion gained traction that children are more or less safe from contracting COVID-19 and if they do get it, it’s not serious, even as the delta variant surged. What are the facts about COVID-19 can children?
Dr. Bui: In early 2020, as scientists and clinicians were learning more about COVID-19 we quickly realized that this was not your common virus. As we learned more, pediatricians and parents alike were relieved that it seemed that the respiratory symptoms and severity did not seem to be as significant for children as it was for adults. We awaited larger data, but we were glad to be able to provide some reassurance to caring and concerned parents. This narrative evolved into people thinking that children could not get it at all and could not spread it to others. Unfortunately, this is false. Throughout the pandemic, approximately 5.1 million children have been infected with COVID-19 and 1.9 million of those children are between 5-11 years old. We know that in the 23 states that report data, there have been over 24,000 pediatric hospitalizations and more than one-third had no underlying medical conditions. With the surge in the delta variant and increased pediatric cases and need for hospitalization, pediatric hospitals experienced unprecedented needs for pediatric COVID-19 hospitalizations. Some of these hospitalizations are due to another pediatric sequelae of COVID-19 known as MIS-C, Multisystem Inflammatory Syndrome of Children, which is a syndrome of inflammation in multiple organs in a child’s body after having a previous infection. We know there have been over 5,000 hospitalizations for this syndrome thus far. Unfortunately, we have nearly 700 children per most reports. Reassuringly, these numbers are better than we see for adults, but for children this is still very significant. 

Q: When it comes to vaccinating their children, some parents suggest they are more concerned about potential side effects or unknown long-term effects of the vaccine than the risk of their child contracting COVID-19 or becoming seriously ill if they do. Is concern over side effects a legitimate reason not to get your child vaccinated?
Dr. Bui: As a parent, it is hard to weigh risks when it comes to your child. The right answer would be something with zero risk. It is important to weigh risks relatively. At this point, we want children to be interacting with others as they were before as soon as possible. Given that coronavirus in some form is here to stay, the relative risk is the effect of your child having COVID-19, including long-term effects vs side effects of the vaccine. We know that the vaccine for children is a lower dose with a lower side effect profile than that of adults. Most children in the study for the COVID-19 Pfizer vaccine showed minimal side effects such as sore arm, fever or fatigue. One side effect discussed is the risk for myocarditis, or heart inflammation, after the COVID-19 vaccine. Based on what we know, your child’s risk of myocarditis after a vaccine is much less than myocarditis after having COVID-19 infection. In most data review, it is 5-6 times more likely to have myocarditis after infection than after the vaccine. Reassuringly, we also know that most side effects of vaccines happen within the first seven days. Long term effects of COVID-19 infection include long-COVID symptoms of fatigue, concentration and memory issues, joint pain or respiratory issues. Long-COVID has been reported in 8% of children post-COVD-19 infection. As a parent, I wish there was a zero-risk option, but the evidence is clear that the benefits outweigh the risks for vaccination. 

Q: What protection will the COVID-19 vaccination provide children 5-11?
Dr. Bui: In the study for Pfizer vaccine, which is 1/3 the adult dose given in two doses three weeks apart, the results were that it is effective with equal antibody response in children 5-11. In the study of 2,250 kids, with 1,518 receiving the vaccine, three did become infected with a mild course with little to no symptoms and importantly zero children had a severe course requiring any treatment or hospitalization, and there were no deaths. There will be data on how this impacts MIS-C and long-COVID, but with these levels of protection, we will not see MIS-C and not see long-term effects of COVID post-vaccination. As a parent and pediatrician, this is exciting news. This level of data helps us move forward in knowing the vaccination will be the relief we have been hoping for.

Q: Can you explain the public health aspect to getting vaccinating, meaning it isn’t simply about protecting the recipient of the shot, but also the recipient's fellow students, teachers, parents, grandparents, etc.?
Dr. Bui: The foundation of a pandemic is that this a public health issue. Our actions individually impact each other, our families, our communities and even beyond. If children 5-11 are vaccinated, they protect their grandparents, immunocompromised loved ones, the elderly that may still have some risk, their teachers and fellow classmates and their siblings that are still too young for their vaccine. One of the major ways multiple families interact is through their children’s activities and having vaccination for this age group reduces the spread of infection. They can protect everyone from newborns to the elderly by also protecting themselves. We know that with the approval of children 5-11 receiving the COVID vaccine, that 28 million children are eligible. Thus far, this age range has accounted for over 9% of all COVID-19 infection that has been tested, with the likelihood that many have not been tested or included. Vaccinating this group will impact the progress we are making to end the COVID-19 pandemic.

Q: Vaccine skeptics often say they need to do additional research even though the scientific community has published mounds of evidence that the vaccines are safe and are the pathway to ending the pandemic. What would you tell those who are skeptical?
Dr. Bui: I think it is always OK to have questions about your child. I cherish the opportunity to have a conversation about concerns with patients. Most physicians and scientists would love to share what they know and are thrilled to have an opportunity to help your child. Similar to conversations had throughout your child’s life, from newborn and beyond, we are here to help. For some, reading on their own helps. I would recommend looking at the recommendations of the American Academy of Pediatrics and I always recommend bringing in what you are reading to ask a physician you know and trust. In terms of the science, it is there. This process has not been changed significantly for COVID-19 and we use studies and data with a volume of cases to ensure that we are making a decision that will significantly reduce infection, hospitalizations and death. Each and every case matters, but looking at all the numbers gives you the big picture. This is an important perspective when doing your own reading.

Q: If the vast majority of children in Texas (and the country) get vaccinated, will it make a difference in combating the virus and returning us to a more normal state of living?
Dr. Bui: The COVID-19 vaccine is our opportunity to return to normal safely. We have seen the impact on children and our community with measures of separation or limited activity, and reducing the severity and spread is key. The COVID-19 vaccine for children 5-11 is 90-100% effective in reducing severity, and vaccines still reduce spread at some level even with the delta variant. The burden on schools, daycare centers and childcare-related activities will greatly be reduced knowing the majority of their students are vaccinated. If the majority of children in this age range and their families are vaccinated, we could resume a lot more of normal childhood activities without a concern of COVID-19 severe disease in a child or family members and loved ones.  

Q: Finally, until children are vaccinated, what is the medical community's advice to parents regarding holding events such as indoor birthday parties or sleepovers?
Dr. Bui: Since the pandemic began, we have learned a lot about how to stay safe. For reference, the CDC and American Academy of a Pediatrics was comfortable with children celebrating Halloween this year given a few simple modifications and hosting events outdoors such as trick-or-treating, trying to incorporate masks and very importantly not engaging with others if you are sick. Longer and larger events that are indoors are still challenging primarily because children are close to one another, they share food, toys, they may wrestle or share their mother's makeup. When we know that children are largely vaccinated or at least have the opportunity to be vaccinated, these childhood fun staples can continue much more safely. 

We are fortunate that there are many ways to get your child's vaccine within the next few days. Pharmacies are safe and effective locations and allow many scheduling options. You may see local organizations hosting fairs related to your child's school or other community events, and you may receive your vaccine at your pediatricians' office. My practice is excited to offer the vaccine to children in a place they likely know, but all of these are excellent options and will protect your child and also take us another step out of this pandemic.