In June, children as young as six months finally became eligible for COVID-19 vaccines when infant- and toddler-sized options from Pfizer and Moderna were authorized. But now that the highly contagious BA.5 Omicron subvariant is driving increased transmission around the country, some children who have started their vaccination course may get infected before they can complete it.
This is particularly true for children ages six months to four years old who are receiving the Pfizer vaccine, which requires three doses—with the third dose coming two months after the second. Kids ages six months to five years old who get Moderna’s vaccine will complete their course much more quickly, with two doses in four weeks.
Here’s what pediatricians say to do if your child gets COVID-19 between doses.
Hold off on the next dose until the child recovers
Pediatricians say that getting COVID-19 in between doses should not significantly alter a child’s vaccination schedule, beyond waiting for the child to recover.
“If you get COVID in between your vaccine doses, you need to wait until you’ve completed your isolation before you get your second dose,” says Dr. Tina Tan, a pediatrician at Lurie Children’s Hospital in Chicago and professor at Northwestern University. Going to a vaccination appointment while battling COVID-19 could spread the disease to others.
But after a child’s isolation period has ended—typically ten days after they first tested positive or started showing symptoms—the child is clear to receive an additional shot, Tan says. “It doesn’t matter if it’s between the first and the second, or the second and the third. You do the same thing.”
Wait a few weeks if you want—but not too long
A child who recently recovered from COVID-19 may wait up to three months to get vaccinated, according to guidance from the U.S. Centers for Disease Control and Prevention (CDC). There is no specific federal guidance for how to navigate the increasingly common scenario of a child getting infected between doses—beyond the CDC saying that if parents find their child in this position, they should wait until the kid has recovered before getting the next dose—but waiting three months after recovery is also fine advice for children who get sick in between doses, says Dr. Ibukun C. Kalu, director of pediatric infection prevention at Duke University Medical Center.
“If the child is either trying to complete their primary series or due for a booster, it is reasonable to use that three-month guideline,” Kalu says. A child’s age or the type of vaccine they received does not change this guidance.
The U.K.’s National Health Service recommends that children wait three months after recovering from COVID-19 before receiving a vaccine, while the New York State health department advises parents to talk to their pediatricians about this option if their child get sick between doses.
However, a three-month delay is not required, and some experts say that children should stick to the same dose schedule they would have followed had they not been infected. “If that dose [appointment] is far enough out that they’ve recovered from COVID,” there’s no need to reschedule, Tan says.
Sticking to existing appointments may be especially helpful if a child is about to go back to school or other settings where they’re likely to encounter the coronavirus. BA.5 is readily infecting people who already had other versions of COVID-19, with some reinfections occurring in less than one month.
Dr. Katelyn Jetelina, an epidemiologist and science communicator who writes the popular Your Local Epidemiologist newsletter, says that if one of her daughters—who both received the first dose of the Moderna vaccine in late June—got infected between doses, she would consider pushing their second shots out by a couple of weeks. “I wouldn’t delay it much more than that,” she says.
Make sure to finish the vaccination course
Completing the vaccine series after a child recovers from an infection will ensure that they have broad protection against future infections and hopefully future variants, experts say.
Here’s why vaccination after infection matters: since many children have mild cases of COVID-19, their immune systems may not “mount a very durable, strong response” to the infection, Jetelina says. The vaccines are designed to provide immune systems with more information about the virus and bolster that response, making kids more prepared “in case they come into contact with the virus again.”
Vaccination can also provide more long-term protection against new variants. “With Omicron and its subvariants, you can get infected again and again and again,” Tan says. “It’s really important that you get your antibody titers up there so that you are protected.”
While COVID-19 tends to be less severe in children than in adults, the disease can still put kids in the hospital. More than 70,000 children in the U.S. have been admitted to hospitals with COVID-19 in 2022 so far, according to data from the Department of Health and Human Services. During the first Omicron surge in January and February, 37,000 children were hospitalized.
In that winter surge, nine out of ten children ages 5 to 11 who were hospitalized for COVID-19 were unvaccinated, according to a CDC report. Vaccinating children reduces their risk of hospitalization and death. And while there’s scant research yet on whether it reduces the long-term effects of COVID-19 in kids—such as Long COVID and multisystem inflammatory syndrome in children (MIS-C)—studies have shown that vaccination reduces the risk of Long COVID among adults.
Prepare for future doses
Experts are also encouraging parents to consider COVID-19 vaccination as part of their back-to-school preparations.
When schools reopen for in-person instruction, many will have fewer safety measures in place, like masks and social distancing, than in the past. “Kids are going to be exposed, probably on a more frequent basis than they are now, to people infected with COVID,” Tan says. She recommends ensuring that children are up-to-date on other routine vaccinations before the semester starts, as well.
Later in the fall, children may have the opportunity to receive booster shots tailored to the Omicron variant. Moderna is currently testing an Omicron booster for children under age five that’s similar to their Omicron booster for adults, which may be available as early as September. This could be a third dose for kids who received Moderna’s primary series, Jetelina says. It’s also currently unclear whether an Omicron-specific booster will be recommended for young kids who receive the Pfizer series, she says.
But parents shouldn’t wait for potential variant-specific vaccines when they can improve their children’s protection against COVID-19 now, experts recommend. “I think the relative unknown that we all face about upcoming variants has encouraged people to get their kids vaccinated as soon as they can,” Kalu says.
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Contributor: Betsy Ladyzhets