COVID-19 Vaccine in Children With Disabilities and Complex Healthcare Needs

COVID-19 Vaccine in Children With Disabilities and Complex Healthcare Needs

Author: Dr. Kathleen Muldoon & Dr. Megan Pesch
As of today, 193 million people ages 12 and over have been safely vaccinated against COVID-19 in the US. The kid-sized Pfizer-BioNTech COVID-19 vaccine was recently authorized for children 5 to 11 years of age. 28 million children are now eligible for vaccination, including approximately 1 in 6 children with a developmental disability. [1]  Recent statistics show why pediatricians and infectious disease experts at the National CMV Foundation support the vaccine for younger children, including for children with disabilities.

In the U.S.: Vaccination against COVID-19 offers many benefits to children. The COVID-19 vaccine:
  • protects children from spreading the virus to family, friends, teachers and people in the community who are at higher risk
  • safeguards children from getting multisystem inflammatory syndrome (MIS-C), a rare but serious condition associated with COVID-19
  • prevents children from potential long-term effects of COVID-19 such as loss of taste and smell, fatigue, and memory problems
  • reduces the risk of school closures due to outbreaks, interrupting learning environments and access to resources and support teams
Because children with complex healthcare needs and disabilities may be at higher risk for more severe illness from COVID-19, the National CMV Foundation asks families and caregivers to strongly consider vaccinating children with underlying health condition or disability.

One of our experts is pediatrician and NCMVF President-Elect, Dr. Megan Pesch[5] . Dr. Pesch is a developmental/behavioral pediatrician at CS Mott’s Children’s Hospital in Ann Arbor, MI and assistant professor at University of Michigan Medical School where her research focuses on health services delivery around congenital diseases, autism and childhood obesity. She is also mom to three girls, her youngest born with congenital CMV.
In this blog, I summarize conversations with Dr. Megan Pesch to answer your questions about the COVID-19 vaccine.

Is the Pfizer-BioNTech vaccine effective and safe for children 5-11?
The Pfizer vaccine was shown to be safe and protective against COVID-19 among children in this age range. A study of 3,200 children [6] conducted by Pfizer shows that the vaccine was 90% effective at preventing symptoms of COVID-19 in 5 to 11-year-olds, and that their immune response was comparable to that in people 16 to 25 years old. Like what we see in other age groups, the side effects experienced were sore arms, redness of the arm, and sometimes swollen lymph nodes, fever, and chills. Inflammation of the heart (myocarditis) is a treatable but serious side effect that occurs very rarely in older teens and adults. Health experts think the smaller dose vaccine for kids 5 to 11 may reduce their risk of myocarditis, and there were no cases reported in in the clinical trials. However, these trials were probably not large enough to detect such rare events.
What are common and “normal” side effects of the vaccine?
Like other routine immunizations, some people have side effects after getting the COVID-19 vaccine. Side effects usually last one or two days and usually do not prevent the person from participating in daily activities. After getting the COVID-19 vaccine a person may have:
  • A sore arm
  • Muscle aches
  • Headache
  • Fever/chills
  • Tiredness
Children may have these side effects after vaccination that make them uncomfortable, but there are steps you can take to help them feel better, like giving them non-aspirin pain relievers (Tylenol or Ibuprofen) or making them comfortable with quiet activities. If your child has serious side effects, go to a hospital or call 911.
Potential concerns
  • History of allergies: Children with more severe allergies to things not listed above usually do not have a problem with the COVID-19 vaccine. They will be asked to wait about 30 minutes after the shot to monitor symptoms.
  • Myocarditis and pericarditis (heart inflammation): CDC has received reports of myocarditis and pericarditis in teens and young adults after the Pfizer and Moderna vaccines. It is more common among males. This rare condition does not appear to be linked to any underlying health conditions. Most cases have been mild and are treatable. The known benefits of COVID-19 vaccination far outweigh the risks. Learn more at CDC: Myocarditis and Pericarditis Following mRNA COVID-19 Vaccination ( coronavirus/2019-ncov/vaccines/safety/myocarditis. html).
Is the Pfizer-BioNTech vaccine safe for children with underlying conditions?
Children with underlying conditions are the ones who benefit the most from the vaccine since they are at higher risk for serious illness from COVID-19. Of the 3,200 children in the Pfizer study[7] , 12% had underlying conditions and none had serious side effects from the vaccine. Data on the 193 million adults and older children that have already received the vaccine, many of whom had underlying medical conditions, also determined that there is no additional safety concern for this group. Children with underlying medical conditions can receive a COVID-19 vaccine. The only reason a person should not receive the vaccine is if they have had a life-threatening reaction (a reaction that requires an epi pen) to any of the ingredients in the COVID-19 vaccine.
I don’t know if my child is allergic to anything. Is it still safe to get the vaccine?
Children who have common allergies to milk, pollen, or latex are not at increased risk of allergic reaction to the COVID-19 vaccine. Severe allergic reactions, or anaphylaxis, to the Pfizer-BioNTech vaccine are very rare in adults, occurring at about 5 cases per million doses. People who have had a severe allergic reaction to the vaccine are allergic to a specific ingredient in the vaccine that is called polyethylene glycol (PEG). By the time a child reaches the age of 5, children who have had the recommended childhood vaccinations have already been exposed to this ingredient. If a child did not have a severe allergic reaction to those vaccines, that is a good indication that they would not be allergic to the Pfizer vaccine.
What is in the vaccine?
The ingredients[8]  in the Pfizer vaccine for children 5-11 years old are:
  • mRNA
  • Fats (lipids)
  • Salt (sodium chloride)
  • Sugar
  • Buffers (Tromethamine is a stabilizer that keeps the vaccine solution at the right pH)
The Pfizer COVID-19 vaccine does NOT contain eggs, preservatives, or latex, which makes it much less allergenic.
Requesting accommodations
When you make an appointment or arrive at the vaccine site, make sure you let the staff know that the child in your care might need some extra help. For example, maybe they are unable to wear a mask or sit and wait after the shot. Perhaps bright lights and noisy rooms bother them. You can ask for accommodations such as:
  • Walking around after the shot instead of sitting
  • Having someone vaccinate them in your car
  • Having their favorite person or animal accompany them and help them during the appointment
  • Getting vaccinated in a quiet room away from the crowds
Does treating possible side effects of the vaccine (e.g., headache, arm pain) reduce the effectiveness of the vaccine?
Some studies have shown that giving some children ibuprofen or acetaminophen before some vaccines can impair the child's immune response. However, the effect of ibuprofen or acetaminophen on COVID-19 vaccine effectiveness has not been studied. To play it safe, avoid giving "preventative" pain medications before the vaccine but use them sparingly if a child does develop side effects like a headache or fever, or general discomfort. For a sore arm, start with an ice pack and/or topical pain medication like salonpas, voltaren, ibuprofen gel or even cooling gel before giving an oral pain medication. For some children with communication differences, locating the source of their pain or discomfort can be challenging. If your child seems generally uncomfortable and is unable to communicate the source of that discomfort, try using other comforting routines before giving oral medication.
Does CMV provide natural immunity for COVID-19?
A prior CMV infection, and immunity against CMV does not provide immunity against COVID-19. These two viruses are from completely different virus families: COVID is a single-stranded RNA virus from the coronavirus family, CMV is a double-stranded DNA virus from the herpes family. They do not have a lot in common.  CMV anti-bodies do not provide protection against COVID-19. Recently it has been hypothesized that people with CMV immunity might be at higher risk of severe COVID-19 outcomes [9] because of the way CMV dysregulates the typical immune response against COVID.
If my child has already had COVID, should they get the vaccine?
Yes, regardless of a prior COVID infection children should still be vaccinated. The vaccine provides better protection against COVID-19 than a prior infection.
My child is almost 12, should I wait to get the adult dose?
Don’t wait for the bigger dose—you never know when COVID will enter your life or your child’s life. Secondly, in addition to being safer, a lower dose in a young age group can achieve a better immune response than even a higher dose.
Can the Pfizer-BioNTech vaccine cause infertility?
There is no evidence that antibodies made after COVID-19 vaccination or vaccine ingredients would cause any problems with becoming pregnant, now or in the future. In addition, studies have found no differences in the ability of people who were vaccinated to become pregnant.
How do I know that severe symptoms won’t start three years after the vaccine?
With the vaccines that are available today, we know that any symptoms that occur usually happen within the first two to three months, and typically much sooner. It has been more than a year since people were first vaccinated in clinical trials, and no additional symptoms have emerged over time. Additionally, there is no biological reason to think that this could happen. For these reasons, it is unlikely that symptoms will occur three years later. The Pfizer-BioNTech vaccine prepared for children in the 5-11 age group is a lower dosage, at one-third the dose for adults. It is likely that there would be even fewer side effects due to the lower dosage.
Will my child need a booster shot?
We don’t know the answer yet. This information can only be determined after assessing the lasting response to the vaccine once it has been administered to enough children in this age group.
How does the Pfizer-BioNTech vaccine prevent hospitalizations if there have been breakthrough infections?
Since COVID-19 vaccines are not 100% effective at preventing infection, some people who are fully vaccinated will still get COVID-19. However, even when fully vaccinated people develop symptoms, they tend to be less severe symptoms than in unvaccinated people. This means they are much less likely to be hospitalized or die than people who are not vaccinated.
How does adding vaccinated children to the population affect herd immunity?
Vaccination helps keeps children from spreading the virus in the community. If a substantial number of children get vaccinated, it will help get the pandemic under control.
Will my child still need to wear a mask if they received the Pfizer-BioNTech vaccine?
In many regions of the U.S., the virus is still very active due to substantial and high community transmission. In these areas, children and adults should continue to wear masks in high-risk situations including in crowded, indoor places where there may be people who are unmasked and unvaccinated. Such locations may include schools and restaurants.
What else can I do to protect my child from COVID-19?
Make sure that you are vaccinated and encourage other people who are close to your child to get vaccinated. That will not only help further protect your children, but it will also help protect yourself and the people around you.
Are there systems in place to monitor the safety and effectiveness of the vaccines?
As the vaccine is distributed to millions of children, it is important to continue to monitor safety. The Vaccine Adverse Event Reporting System (VAERS) solicits reports of any potential illness that occurs after the vaccine has been administered without regard to whether it was associated with the vaccine or not. Then, Vaccine Safety Datalink—composed of 100 million people in the health care system—look at the data and compare it to health records to see if the incidence and frequency at which people are developing a particular symptom can be linked to the vaccine. This system learned about the extremely rare blood clots that occurred with the Johnson & Johnson vaccine, so it works extremely well.  The same system is monitoring vaccine safety in children.
Where can I get the Pfizer-BioNTech vaccine for my child?
The Pfizer vaccine is readily available in retail pharmacies and pediatrician offices. Go to  or call 1-800-232-0233 (TTY 888-720-7489) to find a vaccine provider near you.
Health care providers will be available to answer your questions at the COVID-19 vaccination appointment.
If you have any questions before then, ask a trusted health care provider.
Kathleen Muldoon, PhD
Megan Pesch, MD

Re-posted from Stop CMV AZ
Photo Credit: Jack Lund / Adobe Stock

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