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Ep. 151 - LiveWell Talk On...COVID-19 Vaccines and Children (Dr. William Ching)

episode 151

Ep. 151 - LiveWell Talk On...COVID-19 Vaccines and Children

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Host: Dr. Dustin Arnold, chief medical officer, UnityPoint Health - St. Luke's Hospital

Guest: Dr. William Chingpediatric hospitalist, UnityPoint Health - St. Luke's Hospital

Dr. Arnold:
This is Live Well Talk On…COVID-19 Vaccination and Vhildren. I'm Dr. Dustin Arnold, Chief Medical Officer at UnityPoint Health - St. Luke's Hospital. Last Tuesday, the FDA amended Pfizer's emergency use authorization to include children ages five to eleven, and joining me today's to discuss, this decision as well as his perspective on COVID vaccines. And pediatrics is Dr. William Ching Pediatric Hospitalist with St. Luke's. Dr. Ching, welcome to the podcast.

Dr. Ching:
Thank you, Dr. Arnold. Pleasure to be here.

Dr. Arnold:
Well, to start off just kind of giving me your perspective on the decision that was made to expand this to five and eleven year olds.

Dr. Ching:
I think that the decision to expand the emergency authorization to include children that are five to eleven is a very important next step in our ability to control the, the disease burden, which basically means how much COVID affects our population in general. It does this through broadening the, the population that can be protected against severe COVID. And also from a much broader perspective can reduce the number of children who get sick with COVID and days out of school, days out of work for caregivers and all of that spreads out from each case that we see.

Dr. Arnold:
Yeah, I think, I think you bring up a good point there as with other particularly chickenpox for ourselves that the opportunity to receive the vaccine is not necessarily the sequela the disease, but the logistics of being off school, you know, I mean, I think that's a real consideration when you, when you look at these I, I just, I mean, what's your thoughts on, and that's one thing for adults to take something that's on emergency use authorization. It's just, it's just, I hesitate with children because they're children and what's your thoughts on the, the safety and the efficacy data on this particular, can we extrapolate what happens to adults, to children?

Dr. Ching:
So this is something that has been debated and has been studied at length, because precisely as you say, our children are our most important members of our families, and we need to do everything we can to safeguard their health as much as possible. The ethical concerns about any kind of medication or intervention centers around doing no harm. And, and this is a balance between assessing the benefit to the child, the benefit to the population versus potential risks that an intervention can pose. Nothing is a hundred percent. So far, the safety data has been very positive. Particularly in children, there have been several sequeli or possible side effects that have been associated with administration of the vaccine. However, they are very uncommon and very mild, and we tend to see them in older children. One of these is myocarditis, which is inflammation of the heart. And when we see that in our teenagers that has raised concerns for this however longer term surveillance has shown that if it comes up, children recover from it and there, and there is no detectable long term effect to it. I will say that this is in contrast to actually getting COVID where myocarditis is far more prevalent and teenagers and adults who get COVID and has potentially far more severe and in certain cases, unfortunately has been shown to have long-term effects.

Dr. Arnold:
Do you know when typically when a vaccine is studied about how many children do they enroll in those studies and about how long do those studies go? Do you have any idea?

Dr. Ching:
So there are different stages of this. It is fortunate that in, in recent years there is a requirement that newer medications are studied in children. In the past, we would just, they would just be studied in adults. And then based on a paradigm of, well, kids are just small people. They would just take the data for adults and say, it's good for adults. It's good for kids. Fortunately,

Dr. Arnold:
When I say that, by the way that kids are people, Dr. O'Connor loves it. When I say kids are just small people,

Dr. Ching:
There small and much cuter

Dr. Arnold:
Yeah. Sorry To interrupt.

Dr. Ching:
So, so the, so as one can imagine, generating, setting up a study that involves children is going to be a lot harder and aspiring to involve smaller numbers of kids. Because there are large, there are many, many layers that are at the institutional level, at the governmental level at the company level that are all set up to protect children and to protect those who participate in these studies and to make sure that the caregivers who bravely say, let's study this, have the information they need to make an informed decision to enroll their children in these studies. For the data that were submitted for this authorization. There were over 3000, which, and the surveillance for the, for that population is ongoing.

Dr. Arnold:
So the, if I'm hearing you the data that was presented the myocarditis was rare to absent.

Dr. Ching:
As far as I know, there were zero cases of myocarditis.

Dr. Arnold:
Well, that's reassuring because we know what's kind of the adolescent male, the kids, you know, but you're right. Studies in children are just as complicated as studies in pregnancy. I mean, what, the pregnant woman is going to participate in a study to see if a certain medication causes harm to her baby. I mean, that's just not going to happen, you know, and that's a no brainer.

Dr. Ching:
Unfortunately, we've had, we have observational data looking at the effects or lack of effect, or lack of association of the administration of the vaccine in terms of pregnancy outcomes.

Dr. Arnold:
And that particular, yes,

Dr. Ching:
Very, very large international studies, there is no change in the rate of miscarriage. There's no rate and change of number of pregnancies that go to term between folks who received the vaccine and folks who didn't. So that's been very reassuring. However, we do know that folks who get COVID when pregnant are at a vastly increased risk of prematurity, admission to the NICU morbidity and mortality for for the mom, and that's something that should certainly be thought about. And it's the grounds for very strong recommendation from every professional society that treats pregnant women and babies to receive the vaccine.

Dr. Arnold:
Yeah. But I also on the same thought, I, I understand the trepidation of a pregnant woman would have to try something new, completely get it. I mean, totally get it. Parents are obviously gonna be a little hesitant to receive this because of the unknown long-term effects. But, you know, I think we can say with some confidence, I'd like your opinion on it, that we know that the COVID vaccines don't have some sort of overwhelming, really common sort of side effect. That's disabling because we've given over, you know, X, billion of doses and just not seen that.

Dr. Ching:
And that's, that's very reassuring. The other thing that comes with it is that to date, no vaccine has been associated with long-term side effects war than about three to four weeks out. And this is especially relevant to the mRNA vaccines where the mRNA is, is destroyed by the body within hours of administration. So mRNA is one of the most targeted for destruction molecules in the body. And that is a component of its safety, is that wherever the body can find any more of this mRNA, it's, it will be destroyed. And that is a very important thing that improves the safety of this vaccine.

Dr. Arnold:
Do you think that, is there a certain children? I mean, is it just like adults? I'm sure this is correct, but that we should consider vaccination rather strongly because of a chronic medical condition.

Dr. Ching:
Yes. There are number of children that, that would fall into that category specifically. Thinking about those who would be at increased risk either for cardiac respiratory or immune issues. So those that we currently recommend receive the flu vaccine would be children that we would recommend or receive the COVID vaccine due to their higher risk of respiratory issues or cardiac issues, immunocompromised children, children with cancer children who have received stem cell transplants, children who are receiving immunosuppressive therapies, such as those with rheumatologic disorders. These are all candidates for the COVID vaccine that I would push hard to protect them from it. Another route would be children who are contacts with people who are at higher risk of COVID morbidity, namely those with close contacts that are immunocompromised, those who have lung disease or heart disease this way, this protects the close contact from spreading from the child to that individual or individuals. So these would all be children that I think would be much more for which the vaccine would provide in much stronger indication.

Dr. Arnold:
We'll continue discussing COVID-19 vaccine for children just one minute. But first I want to tell listeners about a new segment on the podcast, the mailbag, do you have a question about COVID-19 the latest medical technologies or procedures services provided at UnityPoint health, Cedar rapids, or other medical topics? You can submit your questions to me a unitypoint.org/mailbag, and they may be answered on a future podcast. Please note, the mailbag is not an alternative to medical appointment or medical care under a physician. Any questions about personal symptoms or conditions need to be directed to your primary care provider or an urgent care, and as always in the case of an emergency call 911, or go to your nearest emergency department, once again, you can submit your questions to unitypoint.org/mailbag that's unitypoint.org/mailbag, M A I L B A G. I look forward to hearing from our amazing listeners. Dr. Ching back to the vaccine. Do you think, do you think that one third dose is going to convey less immunity or have less of an immune response?

Dr. Ching:
So it's, this comes back to the question of our children, little, little adults and it's, and this is, this has been one of the reasons why the emergency authorization has taken so long is looking at experimental data in vitro and in vivo to see what dose regimen would work. Basically walk that fine line between generating a good immune response while minimizing side effects. So that's the reason that the one third dose was arrived at as, as something, that balance as well, the ineffective immune response versus increasing the possibility of side effects. The second thing is that the one reason this is a two dose regimen that is spaced apart so that it gives the body time to be primed. So that the second dose has a much better chance of generating a good immune response.

Dr. Arnold:
Yeah. We talked on previous podcast that you know, one immunologists, the body has to learn how to make the antibody, and then also remember how to make the antibody, you know, and that's, that's why the regimens goes on like that. Last podcast we had in the mailbag, we had a mom asked about her child if they're 11, when they start the series and in turn 12 during the series. And we did answer that question confidently, that they just received the dose of that day, the, the age they are at that day. But another one came up and I, I really didn't know the answer. And maybe it's a benign answer, but what's so special about age 12. Why did they win? Why did they stop at 12?

Dr. Ching:
So, well, there's a, is a, is an it's a category. There is nothing magical that appears between 11, 364 days and a quarter and 12. It's, it's pretty much how the study was conducted. And that's how that's how that consistency in categorizing children who receive the vaccine and are in, are checked for effects and things like that to make that analysis much more reliable. That's, that's essentially the the reason for that,

Dr. Arnold:
Well, as a father with two daughters, I can say confidently that there is a difference between 364 days of being 15, and then turning 16 that the attitude does change overnight. So that I can say with confidence. One last question, Dr. Chang, why did you choose to be a pediatric hospitalist? Take us through your story.

Dr. Ching:
So one of the questions was what kind of medicine to go into, and sometimes folks were would ask the question, do you want to be a surgeon, or do you want to treat people at a medical level? One thing people here don't know is that I started life doing research in pediatric neurosurgery and spinal cord ingeneration. And that was the first part of my career. And one thing that we looked at was was how do spinal, how can we find ways to help the spinal cord regenerate and looking at that, what model can we use that would be looking at the developing nervous system? And the study of pediatrics is the study of change and the study of how do we go from small amount of something, to something that is way more organized and way more complex later. And how do we study that? And along the way, kids are great. And, andmy son is my life. And even at four o'clock in the morning,

Dr. Arnold:
So you have one, you have one job, one job. And how old is He?

Dr. Ching:
He is 18 months.

Dr. Arnold:
Oh, gosh, You got a lot in store for you, my friend. Yep. Mine are 17 and 20.

Dr. Ching:
So, so that's, so that's the road to pediatrics. When I decided that I would be able to do more and, as far as hospital medicine, it's, it's about solving complex problems and creating a model or order out of what seems to be chaos, finding out what, what can we, what, how can we intervene to bring this child back to wellness? And that's rewarding because at the end of the day most of our kids, fortunately, we get to send home and the kid who was miserably sick a couple of days ago, smiling. That's why we do this. And the ability to spend time with them while they're in the hospital and to get to know the families is, is, is a treasure. And, every day I'm grateful to the families for allowing me to be a part of their lives for that short period of time.

Dr. Arnold:
Well, we're, we're certainly glad you're here. You do a great job. And that was why we asked you to be on the podcast today. Dr. Ching, thank you so much for joining me. This is great information. Once again, this is Dr. William Ching, pediatric hospitalist with St. Luke's. If you're interested in having your five to eleven year old vaccinate COVID-19, I suggest that you strongly suggest you discuss that with your pediatrician or primary care provider. For more information on all things COVID visit unitypoint.org. Thank you for listening Live Well, Talk On if you enjoyed this episode, don't forget to subscribe. And if you want to spread the word, please give us a five star review and tell your family, friends, neighbors, strangers about our podcasts. We're available on Apple Podcasts, Spotify, Pandora, or wherever you get your podcast. Until next time be well.