Vaccinating children is necessary, although Covid’s risks are low, warn doctors

A month after her son, Eran, recovered from a mild Covid case, Sara Bittan rushed the three-year-old to the emergency room. He had a high fever, hives, his eyes and abdomen were swollen and red, his stomach ached, and he was crying with pain.

Finally diagnosed with the rare pediatric multisystem inflammatory syndrome (P-SIM), Eran was hospitalized in October for a week and has fully recovered, according to Bittan.

“It’s important for me to tell fathers and mothers around the world that there is a risk. They should know,” the mother said. “Eran suffered a lot, and I suffered with him.”

Two years into the Covid-19 pandemic, doctors around the world are learning more about how the disease impacts children.

While cases of severe illness and death remain far rarer among pediatric patients than in adults, tens of thousands of children may struggle with its consequences. The US Centers for Disease Control and Prevention (CDC) cites Covid-19 as one of the top 10 causes of death among children ages 5-11.

A very small percentage can suffer serious complications, such as SIM-P, which affects less than 0.1% of infected children. Long Covid – the persistence of symptoms weeks or months after infection – affects children as well as adults.

A growing number of countries are offering Covid vaccine to young children. The European Union will start a campaign to inoculate children ages 5 to 11 next week, while a similar vaccination movement in the US that began in November appears to be losing momentum.

In Brazil, the immunization of this group has not yet been authorized by Anvisa (National Health Surveillance Agency). In November, the regulatory agency received a request from Pfizer for the release of the vaccine for children aged 5 to 11 years. So far, the product is only allowed in the country for the 12 to 17 age group.

Doctors hope that the knowledge they have gained will not only improve treatment but also help parents understand the risks of Covid when considering whether to vaccinate their children.

“The long Covid and SIM-P are an important consideration for getting vaccinated,” said Liat Ashkenazi-Hoffnung, who runs the post-coronavirus clinic at Israel’s Schneider Children’s Medical Center.

P-SIM, which usually occurs a few weeks after coronavirus infection, is caused by the immune system suddenly overreacting, creating inflammation in the heart, lungs, kidneys, brain, and gastrointestinal organs. Affected children can spend up to two weeks in hospital, some requiring intensive care.

The CDC has recorded nearly 6,000 cases of SIM-P in the US, including 52 deaths. The syndrome has an estimated prevalence of approximately 3 cases in 10,000 children, according to Audrey Dionne of Children’s Hospital Boston, about the same number from certain European statistics and the Israeli estimate of 1 in 3,500 children infected and a rate of mortality from 1% to 2%.

Singapore’s Ministry of Health cites 6 P-SIM cases out of more than 8,000 pediatric cases of Covid-19.

‘VERY DISCOURAGED’

Doctors say they have learned to treat the disease better, and most children recover. UK studies looking at children six months and one year after SIM-P show that most problems have been resolved.

“The children of the second wave and now the third wave [da Covid-19] are benefiting from first wave information,” said Karyn Moshal, a pediatric infectious disease specialist at London’s Great Ormond Street Hospital.

A six-month review by Moshal and colleagues published in the Lancet found rare organ damage in children who were hospitalized with SIM-P. Symptoms including mental fatigue and physical weakness usually persisted but resolved over time.

“They tire more quickly. Therefore, school activity is affected because they can only concentrate for a shorter period of time,” Moshal said. “Understanding this is important for both families and young people, because they can get very discouraged, and also for schools and teachers to understand how to deal with it.”

Several studies in the UK and US have found SIM-P to be more likely to affect black, Hispanic and Asian children, although the reasons for this are still unknown.

Identifying long Covid in children presents one more challenge. Determining its prevalence depends on what symptoms are observed and from whom the information is collected — doctors, parents or the children themselves — said Ashkenazi-Hoffnung.

Careful estimates indicate that about 1% of children with coronaviruses will suffer Covid Long, said Zachi Grossman, president of the Pediatric Association of Israel.

Ashkenazi-Hoffnung said his clinic treated about 200 children with Long Covid.

She believes this is probably just the “tip of the iceberg” among previously healthy children and adolescents, who months after being infected experience symptoms such as shortness of breath, fatigue, chest pain, headache, tremor and dizziness.

“This can dramatically affect quality of life,” she said.

Simple actions such as climbing stairs, running to catch a bus or simply standing or walking are intolerable, Ashkenazi-Hoffnung said. Some children developed symptoms similar to those of asthma or hearing loss, and some children who walked began to crawl again because they were very tired and in pain.

Most children recover over time with the help of physical therapy and medication, she said. About 20% still have difficulties.

Ashkenazi-Hoffnung and Moshal noted one more problem in children who suffered SIM-P or long Covid — a sense of stigma and shame.

“I was quite shocked by this,” said Moshal. “You can’t place blame or shame on someone being infected with a disease.”

_{Translated by Luiz Roberto M. Gonçalves}