Unvaccinated young children face difficult six to eight months ahead, warn consultant paediatricians

Several consultant paediatricians say that if Malaysian children between the ages of five and 11 are not given their Covid-19 vaccinations soon, they are in for a difficult six to eight months ahead.

In a joint statement, Datuk Dr Amar Singh HSS, Dr Hung Liang Choo, Datuk Dr Musa Mohd Nordin, and Datuk Dr Zulkifli Ismail highlighted that over the past 16 weeks, there had been 325,559 reported Covid-19 cases in those aged 17 and below (87,829 in those aged 0-4, 132,436 in those aged 5-11 and 105,294 in those aged 12-17).

“Currently, 10.5 per cent of all new Covid-19 cases occur in children aged 5-11. This proportion has been increasing over time,” their statement read.

“As more adults and adolescents get vaccinated, and as schools and kindergartens open, we can expect that this unvaccinated population of young children will have more Delta variant infections. Note that adolescents aged 12-17 years now only account for 3.9 per cent of cases due to the high rate of vaccine uptake.”

The medical experts noted that at the time of writing:

  • 116 children had died since the beginning of the pandemic – 38 aged 0-4 years; 32 aged 5-11; and 46 aged 12-17 years
  • 85 per cent of deaths have occurred since July 2021, showing the impact of the Delta variant on children.
  • 28 of the 32 deaths in the 5-11 years age group occurred between July and October 2021.

“And this happened even with all schools and kindergartens closed. As primary schools and kindergartens reopen, we can expect seven to 10 deaths monthly, or possibly more, for the next six to eight months, in this age group.

“This does not take into account the one in 100 infected with Covid-19 that will be hospitalised, some seriously ill with multisystem inflammatory syndrome of children (MIS-C), and the risk of long Covid-19.

“Hence, if we do not vaccinate our five to 11-year-olds now, they are in for a difficult six to eight months ahead.”

The medical experts suggested using every mitigation measure available to minimise the risk of Covid-19 infection among the young. Among the suggestions were:

  • making sure kindergartens and primary schools have excellent ventilation.
  • ensuring every adult around them is vaccinated.
  • maintaining good filtration/fit mask use.
  • adoption of classroom bubbles.
  • limiting unnecessary social contact.
  • the use of hand disinfection and maintaining physical distancing.

“One suggestion has been to use the Pfizer vaccine for teenagers/adults in children aged 5-11 at a smaller dose. Is this feasible? The vaccine approved for children aged 5-11 years is identical to that for older persons, except that we give 10mcg, instead of 30mcg (one-third the adult dose).

“This would mean administering a 0.1ml dosage of the adult/adolescent formulation, but the logistics of these small volumes are not unprecedented. For decades, our nurses have been administering 0.1ml of IM Vitamin K and intradermal 0.05ml of the BCG vaccine. Training of nurses and vaccinators will be required for them to be familiar with the small volumes,” they added.

They noted that the use of adult formulation among children would be considered ‘off label use’ by the company.

“This means, ‘use at your own risk’, and this may open governments to litigation.

“If we opt to take this approach, we will need parental understanding and consent. As in the delivery of any vaccine or drug, care needs to be taken to avoid any errors in dose during administration i.e., make sure children get only a 10mcg dose.

“Our National Pharmaceutical Regulatory Agency (NPRA) will also need to give conditional approval for such a move. In addition, our NPRA must have vigilant surveillance on vaccine safety signals (side effects) and act early, if any appear. The public and parents should be notified of all serious side effects.”

They added that any approach taken should not deprive the elders of their booster shots.

The doctors noted that different nations used different vaccines to protect their young ones.

“The United States has started vaccinating young children in November 2021 with Pfizer. Israel has approved Pfizer and hopes to start very soon. Singapore hopes to get the new Pfizer formulation by January 2022 and extend their vaccination to cover young children.

“The European Union medical regulators have begun evaluating the use of Pfizer in young children. China has authorised the use of Sinovac and Sinopharm vaccines for children aged 3-17. The United Arab Emirates has approved Sinopharm (for those aged 3-17) and Pfizer (aged 5-11). Argentina is vaccinating children as young as three, with the Sinopharm vaccine. Indonesia, Chile and Ecuador have approved the Sinovac vaccine for children aged six and above.”

They added that Sinovac had been given to more than 60 million teenagers in China, but no safety data had been made public.

“It would be good to get Phase 3 efficacy and safety data on Sinovac before any use in young children. Our Health Ministry has embarked on Phase 3 clinical trials using the Sinovac vaccine for children aged 3-11, but the results will only be available many months from now.

“We hope this opens a dialogue that can enable the early vaccination of our young children. Parents should advocate with the health authorities for the option suggested here.

“If there is no way for the authorities to expedite the Pfizer vaccine formulation for young children, then we ask our Health Ministry and NPRA to kindly consider this option of using 0.1ml of the adult formulation, with appropriate training and briefing of healthcare workers involved,” the doctors added.