- This article was amended on 29 March 2021 to include information about the Green Book, detail about paediatricians' discussions of benefits and risks of vaccination with families and a note about PIMS-TS.
- This article was amended on 29 January 2021 to address paediatricians only.
There is understandably considerable interest among paediatricians and their patients in the rollout of the COVID-19 vaccination programme. This is particularly so in those patients who have been shielding for much of the last year because they are clinically extremely vulnerable (CEV).
We are now in the first phase of the programme during which young people (aged 16 years and over) with specific clinical vulnerabilities will be offered vaccination.1
The Green Book says: “Children and young people have a very low risk of COVID-19, severe disease or death due to SARS-CoV-2 compared to adults and so COVID-19 vaccines are not routinely recommended for children and young people under 16 years of age. Children under 16 year of age, even if they are CEV, are at low risk of serious morbidity and mortality, and, given the absence of safety and efficacy data on the vaccine, are not recommended for vaccination.” 2
While this is the case, vaccinations should not be offered to children and young people who fall outside the categories advised by the JCVI and the Green Book.
The only other group identified by the Joint Committee on Vaccination and Immunisation (JCVI) and the Green Book3 that may be considered for the vaccine during phase 1 are:
- older children (aged 12 years and over) with severe neuro-disabilities and recurrent respiratory tract infections who frequently spend time in specialised residential care settings for children with complex needs.
Such vaccinations would be considered unlicensed use.4 Paediatricians should discuss the benefits and risks and limited safety data with children, young people and their parents/guardians. Any vaccination would need to be authorised by a prescriber (usually a doctor). We would expect that this discussion would take into account:
- the frequency and severity of respiratory infection, and
- the history of hospital admissions, particularly the risk of or previous admissions to paediatric intensive care due to respiratory tract infections.
It is important to stress that at this time the JCVI consider that there are no data to support use of the vaccine in younger age groups or other clinical groups, and we support this view.
There is no evidence that children or young people who have been previously diagnosed with PIMS-TS are at specific risk of future infection with SARS-CoV-2 or recurrence of PIMS-TS. In the rare instance that a child that has recovered from PIMS-TS has a co-morbidity that put them in to a priority group and they are offered COVID vaccination, the potential risks and benefits of proceeding to immunisation should be discussed with the clinician responsible for PIMS-TS diagnosis and management.
With studies to generate the data for children and young people getting underway, evidence will be generated as quickly as possible to enable safe rollout to children and young people.
Lockdown ‘advice’ letters for clinically extremely vulnerable people in England sent on 7 January 2021
We are aware that clinically extremely vulnerable children and young people in England have received letters recently suggesting they would be invited for vaccinations in the next month despite not meeting the criteria outlined by the JCVI. We know these letters have caused confusion and upset for families and paediatricians. These letters should not be solely relied upon to identify those eligible for vaccination at this time; rather, we strongly advise all paediatricians and others involved in vaccination to adhere to the advice provided by the JCVI and the Green Book.
- 1. Those who are clinically extremely vulnerable will be eligible for vaccination in priority group 4 (after those aged 75 and over). Those with other clinical vulnerabilities specified by the JCVI will be eligible for the vaccine in priority group 6 (after those aged 65 and over). For further details see: www.gov.uk/government/publications/priority-groups-for-coronavirus-covid-19-vaccination-advice-from-the-jcvi-30-december-2020/joint-committee-on-vaccination-and-immunisation-advice-on-priority-groups-for-covid-19-vaccination-30-december-2020
- 2. The Green Book, chapter 14a, version 7, published 12 February 2021 assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/961287/Greenbook_chapter_14a_v7_12Feb2021.pdf
- 3. The Green Book, chapter 14a, version 5 (published 21 January 2021)
- 4. The Pfizer BioNTech vaccine is authorised for 16 years and over, the AstraZeneca vaccine for 18 years and over.