Quick reference guide on use of COVID-19 vaccines in children 5 to 11 years of age: Recommendations for use
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- Information on adverse events following immunization (AEFI)
- Dose for children 5 to 11 years of age
- Intervals between first and second doses
- Additional/booster doses
- Timing COVID-19 vaccination with other vaccinations
- Timing COVID-19 vaccination with monoclonal antibodies or convalescent plasma
- Timing COVID-19 vaccination with tuberculosis skin tests (TST) or interferon gamma-release assays (IGRA) to test for tuberculosis
- Vaccinating children with previous SARS-CoV-2 infection
- Vaccinating immunocompromised children
- Managing children with a bleeding disorder or taking medication that affect blood clotting
- Managing children prone to fainting
- Managing pain and anxiety in children
- Managing children vaccinated with non-Health Canada authorized vaccines
Information on adverse events following immunization
Immunization may trigger common side effects such as a sore arm, fatigue, headache, sore muscles and joints, and fever. These side effects are often mild and don’t last more than a few days.
In addition to discussions about these common side effects, health care providers should offer information on the specific adverse events that may occur after COVID-19 vaccination.
mRNA vaccines and the risk of myocarditis/pericarditis
Myocarditis is an inflammation of the heart muscle and pericarditis is an inflammation of the tissue surrounding the heart.
Myocarditis and pericarditis have been reported after vaccination with an mRNA vaccine. Most cases are mild and symptoms resolve quickly after seeking medical care.
Although rare, the risks of myocarditis/pericarditis from mRNA vaccines are higher:
- after the second dose
- within a week of vaccination
- in adolescents and young adults (less than 30 years of age)
- in males more than females
- after Moderna Spikevax compared to Pfizer-BioNTech Comirnaty
The risk of myocarditis/pericarditis in children is unknown.
Vaccinated people should be advised to seek medical attention immediately if they develop any of the following:
- chest pain
- shortness of breath
Anaphylaxis is a rare but potentially serious allergic reaction that can occur after vaccination, usually within the first few minutes to hours after vaccination.
Vaccine recipients should be advised to seek medical attention immediately if they develop any of the following:
- hives (bumps on the skin that are often very itchy)
- swelling of their face, tongue or throat
- difficulty breathing, coughing or wheezing
Refer to “Contraindications, precautions and possible allergic reactions” for more information on how to manage people potentially at increased risk for these adverse events following immunization.
Bell’s palsy (weakness or inability to move the muscles of the face) has been very rarely reported after mRNA vaccines in adults/adolescents.
Parents should seek medical attention if their child experiences facial weakness, drooping or other symptoms involving the face.
Dose for children 5 to 11 years of age
The dose of Pfizer-BioNTech Comirnaty in children 5 to 11 years of age is 10 micrograms using the pediatric formulation.
Children who are turning 12 years of age between their first and second dose should receive the:
- 10-microgram dose of Pfizer-BioNTech Comirnaty (formulation for children 5 to 11 years) for the first dose and
- 30-microgram dose (youth/adult formulation) for the second dose
If a child under 12 years of age inadvertently receives a 30-microgram dose, the dose should be considered valid.
- If that was their first dose and they need a second dose and are still under 12 years of age by that time, the 10-microgram dose should be used for the second dose.
- If they turn 12 between the first and second dose, the 30-microgram dose should be used for the second dose.
For more information, refer to the Quick reference guide for youth and adults (12 years of age and older).
Intervals between first and second doses
The National Advisory Committee on Immunization (NACI) has recommended an interval of at least 8 weeks between the first and second dose for children 5 to 11 years of age.
After the second dose, no additional or booster doses are recommended for children at this time.
Timing COVID-19 vaccination with other vaccinations
As a precaution, for children 5 to 11 years of age, NACI recommends not giving COVID-19 vaccines on the same day as, or within 14 days before or after, a non-COVID-19 vaccine. This precaution is to make it easier to know if an adverse event is related to the COVID-19 vaccine.
Note: Exceptions should be made for vaccines needed for post-exposure prophylaxis, which should be given if indicated even within 14 days after a COVID-19 vaccine.
Timing COVID-19 vaccination with monoclonal antibodies or convalescent plasma
NACI recommends not giving COVID-19 vaccines at the same time as anti-SARS-CoV-2 monoclonal antibodies or COVID-19 convalescent plasma.
The optimal interval to wait between these products and COVID-19 vaccination is not known. Some guidance is available from the Centers for Disease Control and Prevention (CDC). Expert clinical opinion should be sought on a case-by-case basis.
Timing COVID-19 vaccination with tuberculosis skin tests (TST) or interferon gamma-release assays (IGRA) to test for tuberculosis
Tuberculosis skin testing or an IGRA test should be administered and read before COVID-19 vaccination or delayed at least 4 weeks after COVID-19 vaccination. If an opportunity to perform the TST or IGRA test may be missed, testing should not be delayed. However, it may be prudent to re-test (at least 4 weeks post-COVID-19 vaccination) children with negative results who are suspected of having tuberculosis. Re-testing will help to avoid missing cases due to potentially false-negative results.
Vaccination with COVID-19 vaccines may take place at any time after all steps of tuberculin skin testing have been completed.
Vaccinating children with previous SARS-CoV-2 infection
Vaccination after infection helps to prevent re-infection. NACI currently indicates that 2 doses of mRNA may be offered. The number of doses will be updated based on evolving evidence.
Children with SARS-CoV-2 infection can be vaccinated once they are no longer infectious and no longer have acute symptoms of COVID-19. The optimal timing of vaccination after infection is not certain.
For children with a previous history of multisystem inflammatory syndrome in children (MIS-C), vaccination should be postponed until (whichever is longer):
- clinical recovery has been achieved or
- it has been 90 days or more since diagnosis
Vaccinating immunocompromised children
Unlike with adults and adolescents, no additional doses are currently recommended for immunocompromised children 5 to 11 years of age after the primary series.
Ideally, the COVID-19 vaccine series should be completed 2 weeks before the child:
- starts immunosuppressive therapy or
- is expected to have the most robust immune response in their therapy course
However, the COVID-19 vaccine can be given earlier in order to provide protection as soon as possible.
The immune response may be lower in those who are immunocompromised. As with everyone else, these children should continue to follow public health recommendations on preventing infection with SARS-CoV-2 (such as wearing a mask, physical distancing and hand hygiene) even if they have been vaccinated. Vaccination of their close contacts will also help protect the child who is immunocompromised.
Managing children with a bleeding disorder or taking medication that affects blood clotting
When vaccinating someone with a bleeding disorder or who is taking medication that affects blood clotting, the Canadian Immunization Guide advises to:
- control the bleeding disorder before immunization
- use a small gauge needle and apply pressure for 5 to 10 minutes after immunization
Managing children prone to fainting
The Canadian Immunization Guide states that you can reduce the chances of someone fainting with the following measures:
- shorter waiting times in the clinic before receiving the vaccine
- comfortable room temperatures
- preparation of vaccines out of view of recipients
- privacy during the procedure
Assess children to determine if they have a history of fainting during medical procedures or vaccinations or if they look anxious, pale or sweaty. You may want to have these children lay down on a mat in the first aid area or in a reclining chair (if available) to prevent fainting and injury during vaccination.
Managing pain and anxiety in children
A number of resources are available to help manage pain and anxiety for children:
- Clinical practice guidelines for immunization pain management (Immunize Canada)
- Techniques to decrease immunization injection pain (Canadian Immunization Guide)
- Needle pain & vaccine fear resources (Solutions for Kids in Pain, or SKIP)
Managing children vaccinated with non-Health Canada-authorized vaccines
No specific recommendations have been made at this time for children who received a non-Health Canada-authorized vaccine. Therefore, at this time, no additional doses should be offered if the child has received a complete series of a non-Health Canada-authorized vaccine.
If an incomplete series of a non-Health Canada-authorized vaccine as been received, the series should be completed with a Health Canada-authorized vaccine for children.
We will update this section as recommendations become available.
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