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Pediatric Vaccines in the Team-Based Care Model

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Pediatric Vaccines in the Team-Based Care Model

  1. 1. Continuing Education Credits In support of improving patient care, Community Health Center, Inc. / Weitzman Institute is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team. A comprehensive certificate will be sent after the end of the series, December 2021.
  2. 2. Disclosures & Disclaimers With respect to the following presentation, there has been no relevant (direct or indirect) financial relationship between the faculty listed above or other activity planners (or spouse/partner) and any for-profit company in the past 12 months which would be considered a conflict of interest. The views expressed in this presentation are those of the faculty and may not reflect official policy of Community Health Center, Inc. and its Weitzman Institute. We are obligated to disclose any products which are off-label, unlabeled, experimental, and/or under investigation (not FDA approved) and any limitations on the information that are presented, such as data that are preliminary or that represent ongoing research, interim analyses, and/or unsupported opinion. This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) as part of an award totaling $137,500 with 0% financed with non-governmental sources. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by HRSA, HHS, or the U.S. Government. For more information, please visit
  3. 3. At the Weitzman Institute, we value a culture of equity, inclusiveness, diversity, and mutually respectful dialogue. We want to ensure that all feel welcome. If there is anything said in our program that makes you feel uncomfortable, please let us know.
  4. 4. 3 Nov 2021
  5. 5. 46,091,924 cases on 10/18/21 with 747,033 deaths COVID-19 in the United States: TOTAL
  6. 6. COVID-19 Hot Spots
  7. 7. New Reported Cases – United States
  8. 8.
  9. 9. Delta Variant – “like COVID on steroids”
  10. 10. ‘Bully in the Playground’
  11. 11. Pediatric COVID Vaccinations • Pfizer vaccine approvals: – FDA authorized use for ages 5 through 11 years – Advisory Committee on Immunization Practices met on November 2… • Moderna for younger ages: – On hold
  12. 12. Pediatric COVID Vaccination • Vaccination program for children aged 5 to 11 will start “running at full strength” – Second week of November, per the White House • There are 28 million children aged 5 to 11 – Surveys indicate only ~1 in 3 parents will have kids vaccinated immediately – “We have more than enough vaccine for every child 5 to 11.” – Jeffrey D. Zients, the Pandemic Response Coordinator
  13. 13. COVID-19 Vaccinations Across the Nation
  14. 14. COVID-19 Boosters Across the Nation
  15. 15. Percent Fully Vaccinated by State for Total Population
  16. 16. Trusted Resources • Johns Hopkins • CDC • WHO 2019 • Others
  17. 17. Where are we now? Kids don’t catch COVID-19.” Really?! • Infection – 1.9 million 5-11 year olds have been infected – 10.6% of cases (they make up 8.7% of the population)
  18. 18. “Kids don’t get that sick from COVID.” • Hospitalizations – >8300 COVID-19 hospitalizations of 5- 11 year olds • Over 30%, NO underlying condition • Starting in August, 5- 11 had their highest rate since the beginning of the pandemic • Once hospitalized, 1/3 of kids ended up in the ICU
  19. 19. Health Inequity
  20. 20. Where did the flu go?
  21. 21. “COVID is just a bad cold like the flu.”
  22. 22. Risk Factors
  23. 23. Mortality
  24. 24. COVID Now in Top Ten
  25. 25. What about MIS-C?
  26. 26. In for the Long Haul . . . • Most common symptoms: fatigue, headache, insomnia, trouble concentrating, muscle and joint pain, and cough • Post-COVID conditions do occur in children – Less common in children than in adults – 7-8% of children with COVID-19 reported continued symptoms >12 weeks – Can appear even after mild infections • Can have significant impact on quality of life – Limitations on physical activity – Feeling distressed about symptoms – Mental health challenges – Decreased school attendance/participation
  27. 27. Kids Have Cooties, and Teachers, too!
  28. 28. Mask On! And get your shot, too!
  29. 29. Pediatric COVID Vaccine
  30. 30. Show me the Data! • 2,268 trial participants (including 1,518 vaccine recipients) • A “safety expansion” group of an additional 2,379 participants (1,500 vaccine recipients)
  31. 31. Does it work? • Immunobridging – Comparable antibody levels to older age group • 90.7% efficacy – 3 cases in vaccine group, 16 in placebo • Worked well against delta variant – Tested during high delta incidence – Vaccinated sera effectively neutralized delta
  32. 32. Is it safe? • Most common adverse events – Fatigue (39%) – Headache (28%) – Muscle pain (12%)
  33. 33. Safety • Two other adverse events linked to the vaccine: – Lymphadenopathy: 13 vaccine participants vs. 1 placebo participant – Hypersensitivity rash • 5 severe adverse events. None were linked to the vaccine: – Ingestion of a penny (1 person in the vaccine group) – Fractures (2 people in the vaccine group and 1 in the placebo) – Infective arthritis (one person in vaccine group) • No cases of myocarditis, anaphylaxis or deaths
  34. 34. Context
  35. 35. Context
  36. 36. Benefits Not Trivial
  37. 37. More than Just Less COVID
  38. 38. Myocarditis “Flavors”
  39. 39. Myocarditis Deaths
  40. 40. Myocarditis Recovery
  41. 41. Myocarditis After Vaccine
  42. 42. Vaccine After COVID • Prior infection confers variable immunity which wanes over time – 2-5x higher risk of reinfection compared to vaccine • Significant boost in antibody levels • Safe
  43. 43. Vaccine Hesitancy
  44. 44. What do parents think?
  45. 45. What are their top concerns?
  46. 46. Which specific side effects?
  47. 47. Vaccine Hesitancy
  48. 48. Health Equity
  49. 49. Disparities
  50. 50. Disparities
  51. 51. In Children 5 years and Older
  52. 52. Transportation • Shipped on dry ice in thermal container • Use insulated gloves! • Note data logger – “Stop delivery” button, press for 5 seconds • Can transfer to ultra-cold freezer or fridge • Temps must be monitored by a data logger • Ancillary kit = diluent, needles, vaccine cards
  53. 53. Storage and Handling • Ultra-cold freezer (-76F to -130F) – > 6mo, until expired • Pediatric vaccine cannot be stored in freezer – Adult freezer up to 2 weeks • Medical grade refrigerator (36F-46F) – Pediatric – 10 weeks – Adult – 1 month • Protect from light, transport at 36-46F
  54. 54. Administration and Labeling • Both vaccines require dilution; see ancillary kit • Allow to warm to room temperature (~20 min) before diluted • Do not shake! Rock back and forth gently before and after dilution • Pediatric vials: 1.3mL diluent. Adult vials: 1.8mL diluent • Pediatric dose: 0.2mL = 10mcg. Adult dose: 0.3mL = 30mcg • Once vial pierced, good for 6 hours for adult, 12 hours for pediatric • Pediatric vial = 10 doses. Adult vial = 6 doses • May not refreeze
  55. 55. Administration and Labeling • Safety of concern when dealing with multiple types of vaccines! • Pediatric vaccine = orange cap, Adult vaccine = purple cap • Consider separate areas of vaccine preparation – Amount of diluent different for each vaccine • Label drawn up syringes to identify which vaccine it is • Once vial pierced, draw up all doses from vial and label – Best practice is to not leave partially filled vials – Consider separate areas for different vaccines
  56. 56. Post-Vaccine Observation Period • 15 minute post-vaccine monitoring period • Logistical considerations – Volume/demand – Vaccinators – Spacing – Other support staffing (greeters, registrars, etc.) • Response (“code”) team considerations
  57. 57. Resources • vaccine-misinformation.html • center/making-vaccines/prevent-covid • pfizer-biontech-covid-19-vaccine-emergency-use-children-5-through-11- years-age • • ACIP November 2-3, 2021 Presentation Slides | Immunization Practices | CDC
  58. 58. Additional Resources • AAP-AACAP-CHA Declaration of a National Emergency in Child and Adolescent Mental Health • Pediatricians, Child and Adolescent Psychiatrists and Children’s Hospitals Declare National Emergency in Children's Mental Health

Editor's Notes

  • 11/2: Welcome everyone – today’s topic is Pediatric vaccines…

    Before she died, Ailish Calloway said she wanted to be a doctor.
  • 10/4/21: Here you can see from the map the ‘hot spots’ occurring around the country. The Darker colors mean more active infections: Alaska, the “Mountain West”, some parts of the midwest – Coal mining areas (W Virginia).

    11/2: case levels are flat or falling in more than 40 states, though trouble spots continue to emerge in parts of the West. Alaska leads the country in recent cases per capita, while Colorado has the fastest rate of case growth.Florida, which experienced one of the worst summer surges, now has a lower recent case rate than every other state. Caseloads continue to fall rapidly across much of the South.
  • 11/2/21
  • B.1.617.2 (India) – DELTA variant
    -"like Covid on steroids," Andy Slavitt, former White House senior adviser for Covid-19 response

  • unclear what dosage of Moderna’s vaccine might be authorized for use as a booster for recipients of other vaccines
  • There are 15 million doses ready
  • 11/2: up from 5.6% two weeks ago (total) and 14.6% for elderly (over 65)

  • 11/2:
    Connecticut now 70.8 up from 69.9% 2 weeks ago
    Vermont: now 71.3 up from 70.6%
    Puerto Rico – doing very well: 73.6 up from 72% immunized
    Alaska – 52.7 up from 51.7%
  • Even though they make up 8.7% of the population).
  • There were exceedingly low (only 9) hospitalizations for flu during 2020-2021. At the same time, there were significantly higher COVID19 hospitalizations. Had mitigation measures (masks, closed schools) not been in place, these numbers would have been much higher.
  • But a reminder that 30% had no risk factors at all.
  • There have been 94 5-11 year olds that have died from COVID19. For context, this places COVID19 as the 8th leading cause of death for this age group. More recently (during Delta), COVID19 jumped to the 6th leading cause of death in this age group.
  • MIS-C (multisystem inflammatory syndrome in children) is highest among 5-11 year olds. There’s been 5,217 MIS-C cases reported as of October 4, 2021. 60-70% of patients are admitted to ICU and 1-2% died.
  • Post-COVID conditions do occur in children – Appears to be less common in children than in adults – A national survey in the UK found 7-8% of children with COVID-19 reported continued symptoms >12 weeks after diagnosis1 – Can appear after mild to severe infections, and after MIS-C
  • Kids also significantly contribute to the spread of the virus. Secondary transmission from young school age children can and does occur in both household and school settings
  • 2,268 trial participants (including 1,518 vaccine recipients) followed for at least two months past the 2nd dose
    A “safety expansion” group of an additional 2,379 participants (1,500 vaccine recipients) followed for a median of 2.4 weeks after the second dose. This was done per the FDAs request “to allow for more robust assessment of serious adverse events and other adverse events of interest”.
  • Among 86 million doses, there have been 9 reports of vaccine-induced myocarditis deaths. Among these 9 cases, 6 have been fully investigated thus far. Three deaths were confirmed as myocarditis. Importantly, all three were due to classic myocarditis (caused from infection of a bacteria/virus) and not due to the vaccine. No myocarditis deaths have been linked to the vaccine in the United States.
  • Myocarditis after vaccination in 5–11-year-old population likely lower than rates seen in 12–15-year-olds Underlying epidemiology of viral myocarditis varies greatly between children aged _____5–11 and 12–17 years: substantially lower in children 5–11 years of age Dose used in 5–11-year-olds (10µg) is a third of dose used in 12–15-year-olds (30µg)
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  • Dr. Chang
  • Dr. Chang