Key messages
- Children are at risk and have been seriously ill from COVID-19. Children of all ages can experience short-term and long-term health issues from COVID-19.
- Moderna and Pfizer COVID-19 vaccines are now available and recommended for everyone 6 months and older.
- Everyone should stay up to date with their recommended COVID-19 vaccines (including boosters, if eligible) for the best protection.
- COVID-19 vaccines and routine childhood vaccinations can be given at the same visit.
- Primary care providers are the most trusted source of medical information and advice for parents and caregivers and should strongly recommend vaccination against COVID-19 for all children.
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New CDC COVID-19 vaccine recommendations for children
The Centers for Disease Control and Prevention (CDC) now recommends vaccination against COVID-19 with the Pfizer and Moderna vaccines for children 6 months and older.
Moderna and Pfizer COVID-19 vaccines for children 6 months to 5 years old
The CDC recommends either:
- Moderna COVID-19 vaccine for children aged 6 months to 5 years: Given in 2 doses, 25 mcg per dose, 4 to 8 weeks apart.
- Pfizer COVID-19 vaccine for children aged 6 months to 4 years: Given in 3 doses, 3 mcg per dose, with the first two doses 3 to 8 weeks apart and the third dose at least 8 weeks after the second.
As with older age groups, an 8-week interval between the first and second dose may be optimal for children who are not immunocompromised, as the longer interval may improve vaccine efficacy and reduce the low risk of myocarditis and/or pericarditis associated with mRNA COVID-19 vaccines.
Moderately to severely immunocompromised children should receive 3 doses of the primary series of Moderna or Pfizer COVID-19 vaccines. See CDC Immunocompromised people for more details.
Moderna COVID-19 vaccine for children 6-17 years old
The Moderna COVID-19 vaccine is now recommended for children aged 6 to 17. Previously, only the Pfizer COVID-19 vaccine was recommended for children 17 and under.
The Moderna COVID-19 vaccine is given in 2 doses, 4 to 8 weeks apart.
- Children 6 to 11 years old: 50 mcg per dose.
- Adolescents 12 to 17 years old: 100 mcg per dose (same dose as for adults).
Note: Supplies of the Moderna vaccine for ages 6-11 are expected in LA County by July 7.
CDC Clinical Considerations Update
The CDC Use of COVID-19 vaccines in the United States Interim Clinical Considerations have been updated to include detailed advice on the Pfizer and Moderna COVID-19 vaccines for children 6 months to 17 years old. The CDC has also created the following clinical aids:
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Background
Young children are at risk of serious illness from COVID-19 and the risk is similar or higher than that of other childhood vaccine-preventable diseases. Since January 2020, 202 children ages 6 months to 4 years have died from COVID-19 in the United States, and COVID-19 is among the top five causes of death in children under 5. Since March 1, 2020, more than two million children aged 6 months to 4 years have been infected with COVID-19. During the Omicron winter wave (December 2021-May 2022), the hospitalization rate for children aged 6 months to 4 years exceeded the hospitalization rates for children aged 5 to 11 and 12 to 17 years . Overall, more than half of hospitalized children aged 6 months to 4 years had no underlying medical conditions. See ACIP Slides.
ACIP analysis of efficacy, immunogenicity, and safety data from clinical trials from Moderna (in children 6 months to 17 years of age) and Pfizer (in children 6 months to 4 years of age) demonstrated that the benefits outweigh the risks for both vaccines in these age groups. The trials did not have enough COVID-19 cases to assess efficacy against severe disease, but immunobypass studies showed elevated antibody levels similar to those in adults after a primary series. Both vaccines are expected to provide better protection against hospitalization and death than protection against infection alone, as seen in older children and adults.
For clinical trials of Moderna and Pfizer vaccines, local and systemic adverse effects were mostly mild to moderate and lasted a few days. There were no cases of vaccine-associated myocarditis, pericarditis or anaphylaxis among trial participants, although the sample sizes were too small to capture rare events. Based on the epidemiology of classical myocarditis and safety surveillance of myocarditis and pericarditis in children aged 5-17 years receiving the Pfizer COVID-19 vaccine, myocarditis and pericarditis after vaccination COVID-19 in children should be rare. Extending the interval between dose 1 and dose 2 of COVID-19 mRNA vaccines to 8 weeks may further reduce the risk of myocarditis, especially in men aged 12-39 years.
For more details, see the ACIP slides COVID-19 mRNA vaccine in young children and Moderna COVID-19 vaccine in children and adolescents aged 6 to 17 years. Complete ACIP presentation slide decks can be found on associated meeting days:
- Moderna and Pfizer vaccines for young children June 17 | June 18
- Moderna vaccine for older children and adolescents June 23
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Actions requested from suppliers
Health care providers are urged to strongly recommend vaccination against COVID-19. Please advise patients (and parents/caregivers) that the benefit of COVID-19 vaccines, like other vaccines, is that vaccinated individuals obtain protection without risking the potentially serious consequences of becoming ill with COVID-19. Immunizing children can also help relieve pressure on families by giving children greater confidence participating in childcare, school and other activities.
Actively promote COVID-19 vaccination
- Contact parents/guardians of children 6 months and older and urge them to have their children vaccinated against COVID-19. Encourage them to make sure their children are up to date with their COVID-19 vaccines, including boosters. Please use and share the resources below, which include sample letters and messages, to promote childhood vaccination against COVID-19.
If you are not a COVID-19 vaccine provider
- Sign up for California’s COVID-19 vaccination program. Parents rely on primary care providers to immunize their children, especially those under age 3 who cannot be vaccinated at many pharmacies. Please consider becoming a COVID-19 vaccine provider, especially if serving a pediatric population. Extensive support is available from start-up and beyond.
- For more information, see the flyer Become a COVID-19 vaccine supplier!
- Grant funds are available for providers of “children’s vaccines” (VFC) up to $25,000. Funds can be used to register for the COVID-19 vaccination program and to extend hours. For information, visit KidsVaxGrant
- Refer your patients for COVID-19 vaccination until you can provide the vaccine. Advise them to visit ph.lacounty.gov/howtogetvaccinated (English) and ph.lacounty.gov/comovacunarse (Spanish) to search for a vaccination location by postal code, type of vaccine and age. They can also call the DPH Vaccine Call Center 1-833-540-04738:00 a.m. to 8:30 p.m., 7 days a week if they need help scheduling an appointment, need transportation to an immunization site, or are housebound. Information is also available in many languages 24/7 by calling 2-1-1.
If you are already a COVID-19 vaccine supplier
- Use every clinic visit as an opportunity to vaccinate. Healthy child checks, Medi-Cal periodicity screenings, sports physical exams and other clinic visits are all opportunities for children to get COVID-19 vaccines as well as childhood vaccines. routine that are due or overdue. It’s important to make sure children are up to date with all recommended vaccines when they return to school this fall.
- Wastage of COVID-19 vaccine may occur. Don’t miss an opportunity to offer the COVID-19 vaccine to all eligible children even if it means opening a new vial at the end of the day. Vaccine wastage should be expected even when providers follow best practices.
- Consider vaccinating children who are not your patients. If your practice can offer the COVID-19 vaccination to children who may not have a medical home, please consider allowing your location to be publicly displayed on vaccines.gov.
- Promote v-sure, the post-vaccination health check-up. Through short smartphone and/or web-based surveys, parents and caregivers can tell the CDC how their children are feeling after the COVID-19 vaccination to help the CDC monitor the safety of COVID-19 vaccines. 19 in near real time. Hang vsafe wall art in your practice, distribute v-safe information sheets, and recommend signing up for v-safe during vaccination visits. Note that a parent can register themselves and multiple children using the same mobile number.
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