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 Table of Contents  
REVIEW ARTICLE
Year : 2022  |  Volume : 3  |  Issue : 2  |  Page : 34-36

Do we need to vaccinate every child against coronavirus disease 2019 in India?


Department of Community Medicine, AFMC, Pune, Maharashtra, India

Date of Submission09-Oct-2021
Date of Acceptance07-Feb-2022
Date of Web Publication16-May-2022

Correspondence Address:
Dr. Suraj Kapoor
Department of Community Medicine, AFMC, Pune, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jphpc.jphpc_33_21

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  Abstract 


There has been a lot of debate around the coronavirus disease 2019 (COVID-19) vaccination of children throughout the globe, particularly with many seeing it as a prerequisite for the reopening of schools. Secondary data from government official sites, press information, latest articles, and newspapers were extracted and discussed in the article. Published literature in respect of COVID-19 vaccination in children reveals that the transmission of COVID-19 is much lesser by the children, with milder course especially among younger children. Further, the risk of transmission by the young children seems very less especially with the recent variant of concern, omicron, in which majority of the infected (80%) remain asymptomatic. Hence, the policymakers need to prioritize the pediatric beneficiary for the vaccination. Age-specific morbidity and mortality trends of the country as well as across the different countries may help in deciding the groups within the pediatric population requiring urgent vaccination. Reports suggests that the pediatric population benefitting the most will be the children with underlying comorbidities or medical condition like malignancy, heart diseases, lifestyle diseases including childhood diabetes, obesity, and hypertension, and renal abnormalities. Since the safety and effectiveness of recently launched COVID-19 vaccines needs exploration in pediatric age group, it may be prudent to have pediatric vaccination among the specific groups who are at higher risk of contracting the severe disease rather than going for mass vaccination drive.

Keywords: Children, coronavirus disease 2019, vaccination


How to cite this article:
Kapoor S. Do we need to vaccinate every child against coronavirus disease 2019 in India?. J Public Health Prim Care 2022;3:34-6

How to cite this URL:
Kapoor S. Do we need to vaccinate every child against coronavirus disease 2019 in India?. J Public Health Prim Care [serial online] 2022 [cited 2022 Jul 5];3:34-6. Available from: http://www.jphpc.com/text.asp?2022/3/2/34/345275




  Introduction Top


The coronavirus disease 2019 (COVID-19), which is caused by a severe acute respiratory syndrome coronavirus 2, has continued to adversely affect almost the entire globe. The current pandemic has not only adversely affected the adults but also had severe impact on the children much beyond the education aspects.[1] Majority of parents dream of bringing children back in teaching space, on playing grounds, and on birthday celebrations. Among policymakers as well, there is a lot of debate around the COVID-19 vaccination of children particularly with many seeing it as a prerequisite for the reopening of schools.[2]


  Methodology Top


Secondary data from government official sites, press information, latest articles, and newspapers were extracted and discussed in the article.

Under make in India initiative, India has manufactured indigenous diagnostics, drugs, personal protective equipment, etc., Another indigenous production of COVID-19 pediatric vaccine ZyCoV-D has received emergency use for the age group above 12 years of age. The overview of vaccine is provided in [Table 1]. A few other COVID-19 vaccines for children are likely to be licensed in India in the coming days, however, mere licensing should not be the sole reason to initiate vaccination in all children. Similarly, many uncorroborated notions are favoring vaccination in all the children, like since all the adults are being vaccinated, so all the children should also be vaccinated.
Table 1: Overview of ZyCoV-D

Click here to view


Children under 18 years represents 8.5% of total confirmed cases, with majority of them having asymptomatic infection. The fatal outcomes were observed in only those having underlying medical condition or with comorbidities.[4],[5]

Published literature in respect of COVID-19 vaccination in children reveals that the transmission of COVID-19 is much lesser by the children, especially the younger children are less likely to get infected and even infected with majority of them likely to acquire asymptomatic infection only. Further, the risk of transmission by the young children seems very less[6],[7] especially with the recent variant of concern, omicron, in which majority of the infected (80%) remain asymptomatic. Recent studies have compared the transmission rate of the pediatric age group with the similar respiratory infection and found to be even lesser than the influenza.[8]

We have witnessed the large surge of cases during the second wave of pandemic with more than four lakhs cases per day during peak time. There was scarcity of medical resources, namely hospital beds, oxygen supply, and health-care workforce. But still the morbidity among pediatric age group was significantly less with lesser hospital admissions as compared to adult population. The trend was similar across the globe. Majority of population below 20 years remained unaffected,[9],[10] while this age group represents about 41% of the total population.[11] The mortality pattern also suggests the similar picture with only about 2% of the total deaths contributed by the age group <20.[12] Recent studies suggest lesser case fatality rate (CFR) among pediatric population as compared to adults. However, there was difference in CFR rate among high-income (CFR = 0.01%) and low- and middle-income countries (CFR = 0.24%).[13] The Overall Case fatality rate(CFR) for COVID -19 among paediatric age group is lesser as compared to adult population.[14] Hence, the policymakers need to prioritize the pediatric beneficiary for the vaccination. Age-specific morbidity and mortality trends of the country as well as across the different countries may help in deciding the groups within the pediatric population requiring urgent vaccination.

If we go back in history, pandemics of various communicable diseases indicate the natural course of infection affected the children early, but they usually had a milder course of illness. This indicates many of the children perhaps already got infected and developed immunity against COVID-19.[15] The latest Indian Council of Medical Research serosurvey also suggests children have already got the infection at a similar rate as adults with milder clinical course.[16] Similar results from serosurvey done by Bombay Municipal corporation revealed 51.8% of paedatric population having(Severe acute respiratory syndrome -Corona virus-2) SARS-Cov2 antibodies.[17]

Reports suggests that the pediatric population benefitting the most will be the children with underlying comorbidities or medical condition like malignancy, heart diseases, lifestyle diseases including childhood diabetes, obesity, and hypertension, and renal abnormalities. Since the safety and effectiveness of recently launched COVID-19 vaccines needs exploration in pediatric age group, it may be prudent to have pediatric vaccination among the specific groups who are at higher risk of contracting the severe disease rather than going for mass vaccination drive.[18] A recent published evidence by the European Centre for Disease Prevention and Control suggests that policymakers should examine in detail the vaccine coverage among the vulnerable population like the elderly, daily wage earners, and migrants. with due consideration on issues concerning availability and accessibility of COVID-19 vaccines on a global scale.[19] After exploring all the aspects, the decision about how to progress on pediatric vaccination should be made. It may be prudent to firstly advise the vaccination for older children (e.g., ≥12 years old) who appear to be more at risk of severe and fatal disease than younger children[20] like having any medical condition which may aggravate the disease. The American Academy of Pediatrics also recommends COVID-19 vaccination for all children and adolescents 12 years of age and older who do not have contraindications using a COVID-19 vaccine authorized for use for their age.[21] Among this age group also, priority can be given to the children having underlying chronic conditions like malignancy, heart disorder, lifestyle diseases like childhood obesity, diabetes, hypertension, or renal pathology, which have been shown to confer a risk of hospitalization and severe outcome similar to the risk as seen in adult age groups.[22],[23] Literature also suggests hospital admission of pediatric population having underlying pathology. A large prospective United Kingdom study revealed the underlying neurological conditions in (11%) children hospitalized with COVID-19.[24] Literature also suggests Down syndrome to be the single most important risk factor for hospitalization and death in COVID-19 among pediatric age group.[25],[26]

At present some countries are showing epidemiological shift in form of increase in paediatric age group. There may be multiple reasons for the same .Firstly , it may be due to emerging omicron variant with increase transmissibility ,Secondly it may be due to ease of restrictions . High vaccination coverage among adults may be the other reasonAt present some countries are showing epidemiological shift in form of increase in paediatric age group. There may be multiple reasons for the same .Firstly , it may be due to emerging omicron variant with increase transmissibility ,Secondly it may be due to ease of restrictions. High vaccination coverage among adults may be the other reason. Still, whether at present vaccinating every child over a vulnerable adult in resource constraint country like India should be a matter needs further exploration in detail.

Public health practice is not simple as decisions are made to strike a balance between scientific evidence and larger good of the society and to ally fear/to provide emotional support to the people affected. COVID-19 has touched the lives of each one of us, governments across the globe have taken many public health decisions, but many are yet to be taken.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
'What Will a Return to School during COVID-19 Look Like?' | UNICEF. Available from: https://www.unicef.org/coronavirus/what-will-return-school-during-covid-19-pandemic-look. [Last accessed on 2021 Aug 08].  Back to cited text no. 1
    
2.
Realizing Children's Rights in India. Humanium. Available from: https://www.humanium.org/en/india/. [Last accessed on 2021 Aug 06].  Back to cited text no. 2
    
3.
August 4 SMND, August 4 2021 UPDATED: Ist 2021 23:45. No Need for Kids to be Vaccinated to Attend School: WHO. India Today. Available from: https://www.indiatoday.in/coronavirus-outbreak/vaccine-updates/story/no-need-for-kids-to-be-vaccinated-to-attend-school-who-1836841-2021-08-04. [Last accessed on 2021 Aug 06].  Back to cited text no. 3
    
4.
COVID-19 in Children: Analysis of the First Pandemic Peak in England | Archives of Disease in Childhood. Available from: https://adc.bmj.com/content/105/12/1180.abstract. [Last accessed on 2021Aug 06].  Back to cited text no. 4
    
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Thompson LA, Rasmussen SA. Children and COVID-19 vaccines. JAMA Pediatr 2021;175:876. Available from: https://jamanetwork.com/journals/jamapediatrics/fullarticle/2780948. [Last accessed on 2021 Jul 28].  Back to cited text no. 5
    
6.
Heavey L, Casey G, Kelly C, Kelly D, McDarby G. No evidence of secondary transmission of COVID-19 from children attending school in Ireland, 2020. Euro Surveill 2020;25:2000903.  Back to cited text no. 6
    
7.
Episode #42 – Vaccines and Children. Available from: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/media-resources/science-in-5/episode-42---vaccines-and-children. [Last accessed on 2021 Aug 06].  Back to cited text no. 7
    
8.
Danis K, Epaulard O, Bénet T, Gaymard A, Campoy S, Botelho-Nevers E, et al. Cluster of coronavirus disease 2019 (COVID-19) in the French Alps, February 2020. Clin Infect Dis 2020;71:825-32.  Back to cited text no. 8
    
9.
10.
Dashboard: National Centre for Disease Control (NCDC). Available from: https://ncdc.gov.in/dashboard.php. [Last accessed on 2021 Aug 08].  Back to cited text no. 10
    
11.
Census of India Website: Office of the Registrar General & Census Commissioner, India. Available from: https://censusindia.gov.in/. [Last accessed on 2021 Aug 08].  Back to cited text no. 11
    
12.
90% of Those Killed by Covid in India are Older Than 40, 69% are Men. Hindustan Times; 2020. Available from: https://www.hindustantimes.com/india-news/90-of-those-killed-by-covid-in-india-are-older-than-40-69-are-men/story-glg0Ct4rHQ1YVvZgnckUcM.html. [Last accessed on 2021 Aug 08].  Back to cited text no. 12
    
13.
Kitano T, Kitano M, Krueger C, Jamal H, Al Rawahi H, Lee-Krueger R, et al. The differential impact of pediatric COVID-19 between high-income countries and low- and middle-income countries: A systematic review of fatality and ICU admission in children worldwide. PLoS One 2021;16:e0246326.  Back to cited text no. 13
    
14.
Case Fatality Rate of the Ongoing COVID-19 Pandemic. Our World in Data. Available from: https://ourworldindata.org/grapher/covid-cfr-exemplars. [Last accessed on 2021 Aug 08].  Back to cited text no. 14
    
15.
AIIMS Conducts Sero Survey in Children, Concludes the Impact of Covid Third-Wave Disproportionate on Kids – The Economic Times Video | ET Now. Available from: https://economictimes.indiatimes.com/industry/healthcare/biotech/healthcare/aiims-conducts-sero-survey-in-children-concludes-the-impact-of-covid-third-wave-disproportionate-on-kids/videoshow/83607858.cms?from=mdr. [Last accessed on 2021 Aug 06].  Back to cited text no. 15
    
16.
ICMR Sero Survey: One in Five Indians Exposed to Covid-19 – BBC News. Available from: https://www.bbc.com/news/world-asia-india-55945382. [Last accessed on 2021 Aug 08].  Back to cited text no. 16
    
17.
Over 50% Mumbai Kids Have Antibodies: Sero-Survey | Mumbai News – Times of India. Available from: https://timesofindia.indiatimes.com/city/mumbai/over-50-city-kids-have-antibodies-sero-survey/articleshow/83938985.cms. [Last accessed on2021 Aug 06].  Back to cited text no. 17
    
18.
Opel DJ, Diekema DS, Ross LF. Should we mandate a COVID-19 vaccine for children? JAMA Pediatr 2021;175:125-6.  Back to cited text no. 18
    
19.
Children and COVID-19: State-Level Data Report. Available from: https://services.aap.org/en/pages/2019-novel-coronavirus-covid-19-infections/children-and-covid-19-state-level-data-report/. [Last accessed on 2021 Aug 08].  Back to cited text no. 19
    
20.
Wong BL, Ramsay ME, Ladhani SN. Should children be vaccinated against COVID-19 now? Arch Dis Child 2021;106:1147-8.  Back to cited text no. 20
    
21.
Committee on Infectious Diseases. COVID-19 vaccines in children and adolescents. Pediatrics 2021;148:e2021052336.  Back to cited text no. 21
    
22.
The Lancet Infectious Diseases. Should we vaccinate children against SARS-CoV-2? Lancet Infect Dis 2021;21:889.  Back to cited text no. 22
    
23.
Ledford H. Deaths from COVID 'incredibly rare' among children. Nature 2021;595:639.  Back to cited text no. 23
    
24.
Swann OV, Holden KA, Turtle L, Pollock L, Fairfield CJ, Drake TM, et al. Clinical characteristics of children and young people admitted to hospital with covid-19 in United Kingdom: Prospective multicentre observational cohort study. BMJ 2020;370:m3249.  Back to cited text no. 24
    
25.
Sperrin M,Mcmillan B.Prediction models for COVID-19 outcomes BMJ2020;371:m3777. doi:10.1136/bmj.m3777.  Back to cited text no. 25
    
26.
Zycov D is 66% Effective Against Delta Variant of SARS-Cov-2, Claims Zydus Cadila. Available from: https://theprint.in/health/zycov-d-is-66-effective-against-delta-variant-of-sars-cov-2-claims-zydus-cadila/719832/. [Last accessed on 2021 Sep 03].  Back to cited text no. 26
    



 
 
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