WHERE should young people, specifically adolescents, sit in the COVID-19 vaccination queue? That is the debate raging in medical and epidemiological circles.
In the Doherty Institute’s recent modelling report for National Cabinet, they wrote: “expanding the vaccine program to the 12–15 year age group has minimal impact on transmission and clinical outcomes for any achieved level of vaccine uptake.”
The Doherty’s report was written on the assumption that vaccines would open up to 30–39-year-olds on 31 August 2021 and to 16–29-year-olds from 11 October.
This week, Professor Mary-Louise McLaws, an epidemiologist with expertise in hospital infection and infectious diseases control, has written an editorial for the MJA suggesting we need to consider expanding our vaccine rollout to include adolescents and young adults sooner rather than later.
“The 20–39-year-olds have been carrying 40% of the cases to date,” Professor McLaws told InSight+.
“This won’t change much unless we start vaccinating them fast. If we can vaccinate them, it slows the spread down to the younger group as well.
“This is now a disease of the unvaccinated and anyone, including adolescents and young adults, who haven’t had the chance of being vaccinated.
“In the UK, most of the vaccines had occurred in the older population, then the middle aged. Then they opened up the vaccines to the younger adults but there hasn’t been enough catch up for the impact of the vaccination on the prevalence of Delta in that young community.”
In her Editorial, Professor McLaws wrote that recent rounds of community testing in the UK, where the Delta variant is now the most common strain, have found that children and young adults were more vulnerable than they were to the previously dominant Alpha strain of the virus.
“A concerning development was the high prevalence of infections in children during round 13 of community sampling. The highest burden of infection was in young adults (18–24 years of age: 1.4%; 95% CI, 0.89–2.18%), followed by children aged 13–17 years (1.33%; 95% CI, 0.97–1.82%) and children aged 5–12 years (1.05%; 95% CI, 0.71–1.56%),” she wrote.
In the UK, 57% of 18–24-year-olds had received one dose and 17% had received two doses as of 20 July 2021. The UK government last week announced 16–17-year-olds were now eligible, but there are no plans to give it routinely to 12–15-year-olds (except those in at-risk groups).
Infectious diseases paediatrician Professor Robert Booy doesn’t think we should jump the gun on vaccinating well children and teenagers.
“It remains the case that we will see more severe disease in children requiring hospitalisation and even intensive care, but it also remains the case that a fatal outcome in children is extremely low based on the latest data,” he told InSight+.
Last week, the Australian Technical Advisory Group on Immunisation (ATAGI) extended their recommendation to include children in the 12–15 years age group who have certain risk factors to be prioritised with the Pfizer vaccine. They also recommended Aboriginal and Torres Strait Islander children aged 12–15 years and all children aged 12–15 years in remote communities receive the vaccine.
Professor Booy believes it is wise to wait until there is further data about both the impact of the Delta variant on children and from immunisation trials on younger age groups that are currently taking place in the US. Fortunately, these data are imminent.
“Within the next few weeks there will be a deluge of papers being submitted from the northern hemisphere especially,” he said.
In the meantime, most experts agree the key to stopping the spread is getting vaccines in the arms of young adults as soon as possible.
Professor Booy agreed.
“For the most part, the excellent modelling done by the Doherty Institute tells us we need to vaccinate younger adults to prevent transmission and to prevent occasional severe cases. Children who are well can join the long queue to get vaccinated,” he concluded.
Professor McLaws’ editorial accompanies research published by the MJA that found most children who presented to Australian hospitals during 2020 – when the original Wuhan variant was dominant – with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection had mild disease. Of the 426 hospital presentations of COVID-19-positive children between 1 February and 30 September 2020, only 16 (4%) required hospital medical interventions.
“Severe disease is more frequent in infants than in older children, and in children with other medical conditions or elevated levels of the inflammatory marker, C-reactive protein,” the authors wrote.
Also online first at the MJA
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Sweetman et al; doi: 10.5694/mja2.51200 … FREE ACCESS for one week.