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COVID-19 in Children & the Pediatric Vaccine · The SHEA Podcast

• 0:08
  SPEAKER_01: Welcome to the Rapid Response Podcast, brought to you by the Society for Healthcare Epidemiology of America, or SHA, promoting the prevention of healthcare associated infections and antibiotic resistance and seeking to advance the field of healthcare epidemiology and antibiotic stewardship.
• 0:25
  SPEAKER_01: I'm Dr.
• 0:25
  SPEAKER_01: Josh Shapson, Director of Infection Prevention and Control, and an associate professor of infectious diseases at Cincinnati Children's Hospital Medical Center, and I will serve as your moderator.
• 0:36
  SPEAKER_01: The discussion on the podcast does not reflect Shay's perspective, but facilitates communication of multiple perspectives and experiences as we go through this challenging time together.
• 0:46
  SPEAKER_01: Shay is excited to launch this episode of the podcast with a COVID-19 updates of what we know now.
• 0:52
  SPEAKER_01: Today's discussion will focus on COVID-19 in children, including pediatric vaccination.
• 0:58
  SPEAKER_01: Our speaker today, Dr.
• 1:00
  SPEAKER_01: Andy Shane, is a professor of pediatrics and chief of the division of pediatric infectious disease at Emory University School of Medicine and Children's Health Care of Atlanta.
• 1:10
  SPEAKER_01: Dr.
• 1:10
  SPEAKER_01: Shane is also the Marcinson Professor of Hospital Epidemiology at Emory and Children's.
• 1:16
  SPEAKER_01: Dr.
• 1:16
  SPEAKER_01: Shane, thank you for joining us today.
• 1:19
  SPEAKER_01: Before we start our discussion, I'd like to turn it over to Dr.
• 1:22
  SPEAKER_01: Jennifer Hanrahan to get us started with a brief news and guidance update for the week.
• 1:28
  SPEAKER_00: Globally, as of June 8, 2021, there have been 173 million, two hundred and seventy one thousand seven hundred and sixty-nine cases of COVID-19, including three million seven hundred and thirty three thousand nine hundred and eighty deaths reported to the World Health Organization.
• 1:42
  SPEAKER_00: As of June 5, 2021, a total of almost 2 billion vaccine doses have been administered globally, including over 300 million doses of vaccine in the United States, meaning that 63.7% of people in the U.S.
• 1:55
  SPEAKER_00: have had at least one dose of vaccine.
• 1:57
  SPEAKER_00: In the news this week, an article in the Annals of Internal Medicine examined the safety and immunogenicity of anti-SARS-CoV-2 messenger RNA vaccines in recipients of solid organ transplants.
• 2:07
  SPEAKER_00: This study evaluated patients with heart, kidney, liver, or pancreas transplants in southwest France.
• 2:12
  SPEAKER_00: According to the recommendations of the Francophone Society of Transplantation, anti-SARS-CoV-2 spike protein antibodies were monitored before and after vaccination.
• 2:20
  SPEAKER_00: Authors state that this study, which included many patients with solid organ transplants, confirms a weak immunogenicity of messenger RNA vaccines in those who had a transplant.
• 2:29
  SPEAKER_00: Recipients of liver transplants showed a better humoral response than the recipients of other organs.
• 2:34
  SPEAKER_00: Considering that vaccines were well tolerated, an increased antigen dose or a third vaccine dose may improve the vaccination response in this specific population.
• 2:42
  SPEAKER_00: In France, the French National Authority for Health has recently recommended offering a third dose to immunosuppressed patients.
• 2:48
  SPEAKER_00: Another article in Annals of Internal Medicine describes the absence of humoral response after two-dose SARS-CoV-2 messenger RNA vaccination in patients with rheumatic and musculoskeletal diseases.
• 2:59
  SPEAKER_00: Authors in this study analyzed a subset of 20 patients with rheumatic and musculoskeletal diseases who did not develop a detectable antibody response one month after completion of two-dose messenger RNA vaccination against SARS-CoV-2.
• 3:11
  SPEAKER_00: Patients aged 18 years or older with rheumatic and musculoskeletal diseases were recruited to participate in this prospective cohort assessing SARS-CoV-2 vaccine response through a digital campaign between December 2020 and March 2021.
• 3:24
  SPEAKER_00: One month after the second dose, blood samples were obtained and tested on the semi-quantitative Alexis anti-SARS-CoV-2S enzyme immunoassay, which tests for antibodies against the receptor binding domain of the SARS-CoV-2 spike protein, which is a consistent correlate of neutralizing antibody.
• 3:40
  SPEAKER_00: Twenty participants did not have a detectable anti-receptor binding domain antibody at a median of 30 days after the second dose of the SARS-CoV-2 messenger RNA vaccine.
• 3:49
  SPEAKER_00: Most were female and white, and the median age is 46 years.
• 3:52
  SPEAKER_00: The most common diagnosis was lupus followed by myositis and vasculitis.
• 3:56
  SPEAKER_00: The final two participants reported Schobrin syndrome and sarcodosis.
• 4:00
  SPEAKER_00: Most participants receiving multiple immunosuppressive agents.
• 4:03
  SPEAKER_00: Maintenance corticosterids were a part of 16 regimens with a median dose of 5 milligrams.
• 4:08
  SPEAKER_00: Rituximab was the most commonly prescribed biologic agent, whereas mycophenylate was the most frequently reported disease-modifying anti rheumatic drug.
• 4:16
  SPEAKER_00: The median timing of rituximab infusion before dose 1 was 14 weeks.
• 4:20
  SPEAKER_00: There were no reported diagnoses of COVID-19 during follow-up.
• 4:24
  SPEAKER_00: Rituximab has been associated with worse outcomes in patients with rheumatic musculoskeletal disease and SARS-CoV-2 infection, and thus it is of concern that these patients may not derive protection from vaccination.
• 4:35
  SPEAKER_00: Additional research is required to further characterize the humoral and cellular responses to SARS-CoV-2 vaccination in patients with rheumatic and musculoskeletal diseases.
• 4:44
  SPEAKER_00: Optimization of vaccine response in patients receiving B cell modulating agents may require perivaccination adjustment and dosing and timing of these agents.
• 4:52
  SPEAKER_00: Patients receiving these medications should be aware of the potential for suboptimal vaccine response and the need for ongoing vigilance in observing non-pharmacologic preventive measures.
• 5:03
  SPEAKER_00: And finally, in the New England Journal of Medicine, a study reported preliminary findings of messenger RNA COVID vaccine safety in pregnant persons.
• 5:11
  SPEAKER_00: From December 14, 2020 to February 28, 2021, data from the VSAFE after vaccination health checker surveillance system, the vSAFE pregnancy registry, and the vaccine adverse event reporting system was used to characterize the initial safety of messenger RNA COVID-19 vaccines in pregnant persons.
• 5:28
  SPEAKER_00: A total of 35,691 VSAFE participants aged 16 to 54 years were identified.
• 5:35
  SPEAKER_00: Among 3,958 participants enrolled in the VSAFE pregnancy registry, 827 had a completed pregnancy, of which 115 resulted in pregnancy loss and 712 resulted in a live birth, mostly among participants with vaccination in the third trimester.
• 5:51
  SPEAKER_00: Adverse neonatal outcome included preterm birth in 9.4% and small size for gestational age in 3.2%.
• 5:58
  SPEAKER_00: No neonatal deaths were reported, although not directly comparable.
• 6:01
  SPEAKER_00: Calculated proportions of adverse pregnancy and neonatal outcomes in persons vaccinated against COVID-19 who had a completed pregnancy were similar to incidences reported in studies involving pregnant women that were conducted before the COVID-19 pandemic.
• 6:15
  SPEAKER_00: Preliminary findings did not show obvious safety signals among pregnant persons who received messenger RNA COVID-19 vaccines.
• 6:21
  SPEAKER_00: However, more longitudinal follow-up, including follow-up of large numbers of women vaccinated earlier in pregnancy, is necessary to inform maternal pregnancy and infant outcomes.
• 6:31
  SPEAKER_00: And that's the news.
• 6:32
  SPEAKER_01: Thank you, Dr.
• 6:33
  SPEAKER_01: Hanran.
• 6:34
  SPEAKER_01: And now I'd like to move into the discussion with our speaker.
• 6:37
  SPEAKER_01: Dr.
• 6:37
  SPEAKER_01: Scheng, could you first share the research you've done and currently do around COVID-19 in children?
• 6:42
  SPEAKER_02: Thanks very much, Josh.
• 6:44
  SPEAKER_02: And thank you to the Shea organizers for asking me to participate in this podcast today.
• 6:50
  SPEAKER_02: I just wanted to start out by saying that, you know, as with everything pandemic, COVID-19 and especially research has been very much a team effort.
• 7:00
  SPEAKER_02: One of my main roles really has been to support my faculty as they have collaborated in absolutely beautiful ways to understand the impact of SARS-CoV-2 on children.
• 7:11
  SPEAKER_02: I'm very fortunate to have basic science, translational, and clinical faculty in our division.
• 7:17
  SPEAKER_02: And we've seen tremendous collaborations as all of these have been working together on the front line, our clinicians especially, and working on the patient frontline, while the researchers have been really instrumental in developing and validating assays and processing specimens based on the patients who we have been privileged to take care of in the hospital.
• 7:40
  SPEAKER_02: As part of a partnership between an academic and a clinic in the children's hospital setting, we've also been very fortunate to be the referral center for children with SARS-CoV-2 and SARS-CoV-2 infections and their post-infectious complications, such as MISC and post-acute COVID-19, also known as long-haul COVID-19.
• 8:03
  SPEAKER_02: Another very important clinical collaboration has occurred as ID, cardiology, rheumatology, and hematology colleagues have come together in really multidisciplinary ways to input into the care of children with COVID-19.
• 8:19
  SPEAKER_02: I would also say, like many others around the country, we've really spent hours evaluating and reviewing literature, which came at a pace that actually has never been seen before, and convening groups of colleagues to develop pathways for management, implementing and assessing those guidelines as we went along.
• 8:38
  SPEAKER_02: As those who care for children know, the acute clinical impact of COVID-19 on children has been thankfully less burdensome than that in adults and especially in older adults.
• 8:49
  SPEAKER_02: However, our pediatric patients are taken care of by adults, and we have to be worried about their health care as well.
• 8:56
  SPEAKER_02: And therefore, as a hospital epidemiologist, we have to take into consideration not only the children in the hospital, the healthcare workers who provide care for them, the patient, their family members who provide bedside care and support, and so many others.
• 9:12
  SPEAKER_02: Some of our investigations would not qualify as research in the technical term.
• 9:16
  SPEAKER_02: We have consistently been assessing interventions and finding ourselves having to modify recommendations as more information was gathered.
• 9:25
  SPEAKER_02: So I would say that research really has been all-encompassing from the laboratory to the bedside to the community and the hospital environment and has been very stimulating and exciting at the same time.
• 9:38
  SPEAKER_01: Yeah, thank you very much.
• 9:39
  SPEAKER_01: And I I completely agree.
• 9:41
  SPEAKER_01: The pace has been amazing.
• 9:42
  SPEAKER_01: When we get complaints, I can't believe you're changing so quickly.
• 9:46
  SPEAKER_01: I'm thinking to myself, wow, I can't believe we have such new knowledge so quickly and we're able to make a better recommendation.
• 9:53
  SPEAKER_01: So it's been very, very striking and really wonderful to see the collaboration.
• 9:58
  SPEAKER_01: So as you mentioned, the immediate impact of COVID-19 in children is not as severe or as extensive as in adults.
• 10:05
  SPEAKER_01: But can you talk about the long-term impact of COVID?
• 10:08
  SPEAKER_01: You talked a little bit about long haul and about MISC.
• 10:11
  SPEAKER_01: What can you provide to our listeners on that topic?
• 10:14
  SPEAKER_02: Sure.
• 10:15
  SPEAKER_02: I think we are really only beginning to understand the scope of this pandemic and the impact on children.
• 10:21
  SPEAKER_02: And certainly, you know, in the early months of the pandemic, when schools and childcare and other places where children gather were closed, many children were not interacting with others outside their homes.
• 10:33
  SPEAKER_02: And we saw relatively low numbers of infections.
• 10:36
  SPEAKER_02: Now, some of their parents did have to work outside the home.
• 10:40
  SPEAKER_02: And what we did see in the beginning across the country was that in homes where parents were working outside the home, essential workers, children were more likely to be exposed and to become infected.
• 10:51
  SPEAKER_02: However, as time progressed, we started to see waves of infection in communities, especially as people began traveling, returning to work, returning to school, and participating in extracurricular activities.
• 11:04
  SPEAKER_02: So when I think about the impact of COVID-19 on children, I think about three different impacts.
• 11:11
  SPEAKER_02: I think about the direct and acute, which is the child who is infected and may require either care at home or in some situations may require hospitalization.
• 11:22
  SPEAKER_02: That child recovers and has no further sequelae.
• 11:26
  SPEAKER_02: Then I think about the post-infectious, which is the MISC or multisystem inflammatory syndrome in children, which is a rare post-inflammatory condition that we have seen in a number of children, usually occurs three to four weeks after the initial SARS-CoV-2 infection, which may or may not be recognized.
• 11:47
  SPEAKER_02: And a number of those children have required hospitalization, have required intensive care, and unfortunately, some have also died.
• 11:56
  SPEAKER_02: And then also the PASC-C or the post-acute SARS-CoV-2 associated with COVID, long haul COVID.
• 12:04
  SPEAKER_02: There's lots of different names.
• 12:05
  SPEAKER_02: And these are the post-infectious manifestations of a SARS-CoV-2 infection, which often manifest as fatigue, tremendous fatigue.
• 12:14
  SPEAKER_02: There's a description of brain fog, sort of this inability to focus or concentrate, a number of other symptoms.
• 12:23
  SPEAKER_02: Some children have reported decreased appetite, inability to really sort of function, and a tremendous, overwhelming, profound chronic fatigue syndrome.
• 12:35
  SPEAKER_02: And we're starting to see more of this in children.
• 12:37
  SPEAKER_02: It certainly was recognized in adults when there were more infections in adults, but we're starting to see more in children as children become infected.
• 12:46
  SPEAKER_02: And then finally, the third, which I think is the hardest really to describe and to sort of understand because it really encompasses both the first and the second, and that's the psychosocial and societal impact, which it will probably take a generation for us really to understand this completely.
• 13:04
  SPEAKER_02: So children whose lives have been completely disrupted by not being able to perform their regular routines, go to childcare, attend school, participate in extracurricular activities, just be around other people.
• 13:17
  SPEAKER_02: And so we've seen tremendous numbers and increases, unfortunately, in drug use and drug abuse, in children who have become depressed, behavioral and psychological manifestations, the number of children requiring behavioral health care, which of course has also been very limited during most of the months of the pandemic due to concerns about transmission of infections.
• 13:40
  SPEAKER_02: So really, this pandemic, although the acute impact has thankfully been less than adults, the societal impact and beyond is really something that we're just beginning to understand.
• 13:52
  SPEAKER_01: Yeah, yeah, thank you very much.
• 13:53
  SPEAKER_01: And I really like how you broke that into three pieces.
• 13:56
  SPEAKER_01: Because as a pediatrician, I I agree completely.
• 13:59
  SPEAKER_01: And, you know, it really puts first do no harm in perspective.
• 14:03
  SPEAKER_01: We're trying to have children avoid exposure so they don't become infected, and we're affecting their psychosocial development.
• 14:09
  SPEAKER_01: And how do we face that dichotomy?
• 14:12
  SPEAKER_01: And I think that we're all trying to learn that together.
• 14:15
  SPEAKER_01: And so, given that, now that vaccines have been approved for children as young as 12 and in the future probably younger.
• 14:22
  SPEAKER_01: So, how does this affect their summer activities, their interactions with each other and school come fall?
• 14:28
  SPEAKER_02: So, great question.
• 14:29
  SPEAKER_02: And you know, I think those of us who have watched and taken care of children, and those of us who have children ourselves just felt this tremendous, incredible sense of relief when vaccines were first authorized for older adolescents and young adults, and now down to 12 and trials are ongoing for even younger children.
• 14:51
  SPEAKER_02: And it's it's sort of hard to put that into words.
• 14:54
  SPEAKER_02: And I I guess I just personally didn't think that I would feel anything once the EUAs were issued, but I was just really tremendous and fantastic just to think about the progress that had been made in such a short amount of time.
• 15:11
  SPEAKER_02: And this was an opportunity to really get ourselves back to normal.
• 15:15
  SPEAKER_02: And it you know, it really does present an opportunity for children to do the things that they want to do with their friends and then to socialize after being vaccinated.
• 15:25
  SPEAKER_02: Now, we still have to be cautious because not everybody is vaccinated, and that's another challenge that we have to address.
• 15:32
  SPEAKER_02: So there still is lots of mixing of vaccinated and unvaccinated people, and in those situations, mitigation methods, especially masking and hand hygiene, are essential.
• 15:43
  SPEAKER_02: But being vaccinated really offers people an opportunity to go back towards being more normal, interacting with people with less risk of transmission, and certainly dramatically decreased risk of hospitalization and severe infection.
• 16:01
  SPEAKER_02: So I would say that vaccines are probably the greatest gift that we have received in this in this pandemic.
• 16:08
  SPEAKER_01: Yeah, I agree.
• 16:09
  SPEAKER_01: I didn't anticipate how sort of emotional I would feel and how how deeply meaningful it would be as these became approved.
• 16:17
  SPEAKER_01: I've often looked at previous eras where vaccines were released and later we found out they made a difference and wondered what it was like to be there.
• 16:24
  SPEAKER_01: I don't know if it's similar, but but I agree it was it was really exciting to hear.
• 16:29
  SPEAKER_01: So, what do you think the role of infection preventionists and healthcare epidemiologists will be thinking about the summer, thinking about the fall and school return and how to help folks help children feel more normal?
• 16:42
  SPEAKER_02: Yeah, I think that's that's a great question.
• 16:44
  SPEAKER_02: And we do so much as as pediatricians, as healthcare epidemiologists, as infection preventionists.
• 16:50
  SPEAKER_02: And so I think one of the one of the biggest challenges has been, as you mentioned earlier on in the introduction, sort of the rapidity at which guidance has been changing.
• 17:01
  SPEAKER_02: And we are always very excited when additional guidance comes out based on data that allows us to loosen some of our restrictions.
• 17:09
  SPEAKER_02: But I think one of the big challenges and that we have to continue to remember is that guidance for the community is different than guidance for the healthcare setting.
• 17:20
  SPEAKER_02: And that can be very challenging sometimes, especially for families who are vaccinated and parents who are vaccinated, and even healthcare workers who are vaccinated, none of us really like wearing masks.
• 17:32
  SPEAKER_02: We like being able to see other people's facial expressions.
• 17:35
  SPEAKER_02: Really, sort of 50% of our interactions are covered up, and the mouth is so important in just understanding and communication.
• 17:44
  SPEAKER_02: And so I think everybody would love to just toss the mask away and never see it again.
• 17:49
  SPEAKER_02: But we have seen some very positive things from mask wearing.
• 17:52
  SPEAKER_02: And I think it's really important while we can open up in the community in the healthcare setting where we have possibly incompletely protected people who cannot mount an immune response, or children who are not eligible to be immunized, or children who are ill for some other reason that may not be able to mount an immune response.
• 18:14
  SPEAKER_02: We really continuing to use mosques are is really important.
• 18:19
  SPEAKER_02: We've also seen the secondary benefits on other respiratory pathogens, and certainly we've seen an increase as we have loosened up in the community.
• 18:28
  SPEAKER_02: We're seeing probably throughout the country, at least in the southeast, an increase in RSV and powerful influenza 3, which we do see sometimes at this time of the year, but really in increased rates and rhinovirus as well.
• 18:41
  SPEAKER_02: So we we have to continue to think about that as we work in the hospital.
• 18:45
  SPEAKER_02: And so I think it really is important for hospital epidemiologists and infection preventionists to set the example, to wear a mask for all patients and family-facing care, to be the model for hand hygiene, which is really the basic that won't get us through everything.
• 19:01
  SPEAKER_02: But it's something so simple that sometimes I think we just we forget about it.
• 19:05
  SPEAKER_02: And not only us using hand hygiene, but also encouraging our patients and families to use hand hygiene and making sure that that becomes part of their routine as well, and also encouraging them to wear masks when they're in situations that they're interacting with other people as well.
• 19:23
  SPEAKER_02: And I think the other role of healthcare epidemiologists and infection preventionists is really encouraging vaccines.
• 19:29
  SPEAKER_02: And I'm sure we're going to talk more about that as we go on.
• 19:32
  SPEAKER_02: But really, patients and families and parents look to us as the source of medical advice and medical care.
• 19:39
  SPEAKER_02: And so we have to first of all immunize ourselves, which is extremely important, and then be advocates for immunization and vaccination.
• 19:47
  SPEAKER_01: Thank you.
• 19:47
  SPEAKER_01: Yeah, that's really fantastic.
• 19:49
  SPEAKER_01: You know, we're we're community members, we're community leaders, and we have to lead by example.
• 19:54
  SPEAKER_01: And so showing how we live with these interventions, even though we don't enjoy them any more than anybody else, but we know how necessary they are, it always strikes me how we always come back to hand hygiene.
• 20:05
  SPEAKER_01: In talking with schools a lot, I kept finding myself saying, you know, it's a wonderful life skill to teach our children to frequently wash their hands.
• 20:13
  SPEAKER_01: It'll keep them healthy throughout their lives.
• 20:16
  SPEAKER_01: So in thinking about school and in thinking about the impact of vaccine, so currently there are trials going on in children six months to 11 years old for the mRNA vaccines, but none have applied for EUA or been approved.
• 20:29
  SPEAKER_01: But do you think that the timeline to get them to EUA and out to our children is realistic to do so before school?
• 20:37
  SPEAKER_01: And what do you think we can do to prepare for either scenario, if it does happen or if it doesn't happen?
• 20:43
  SPEAKER_02: So that's a great question.
• 20:44
  SPEAKER_02: And I I'm really hopeful, Josh, that we can get this as many children immunized before school starts as possible, certainly the 12 and above.
• 20:53
  SPEAKER_02: And we'll have to see the pace of the trials has been fantastic so far.
• 20:58
  SPEAKER_02: One of the bigger challenges with the six-month to 11-year-old is that there's some dose finding that has to occur first.
• 21:06
  SPEAKER_02: And so for the Moderna vaccine that's ongoing, and also advisor vaccine that seems to have been completed and now working on looking at those different doses for the different age groups.
• 21:17
  SPEAKER_02: So a little bit different than changing or updating the authorization for the adult vaccine to include the 12 and above because the dose remained the same.
• 21:27
  SPEAKER_02: So that does add some time into the trials.
• 21:30
  SPEAKER_02: But I am still very hopeful, at least that we will be able to have all children an EUA for all children by the end of the calendar year.
• 21:40
  SPEAKER_02: So that may not be in advance of starting school, but still having the majority of children or significant number of children immunized before school starts is going to be really important.
• 21:51
  SPEAKER_02: And also, teachers and staff cannot emphasize that enough.
• 21:55
  SPEAKER_02: And they are high risk groups interacting with lots of children, and obviously adopting.
• 22:00
  SPEAKER_02: And so making sure that they're immunized is really important.
• 22:04
  SPEAKER_02: And I think that the one thing that we really need to do, everybody, but especially healthcare professionals, is start vaccine conversations now.
• 22:14
  SPEAKER_02: So when a child comes into the hospital with a broken leg, making sure that you ask the question of the parents have you received your COVID vaccine?
• 22:23
  SPEAKER_02: And if they haven't, addressing some of the reasons why they may not have.
• 22:27
  SPEAKER_02: And if the child is age eligible, recommending that the child be immunized as well.
• 22:32
  SPEAKER_02: Some healthcare settings are actually offering COVID-19 vaccines in the healthcare setting, and many pediatricians' offices and health departments are continuing to do so.
• 22:42
  SPEAKER_02: So really trying to encourage access is really important as well.
• 22:46
  SPEAKER_02: And we know that parents are much more likely to have their children immunized if it's convenient.
• 22:53
  SPEAKER_02: And so, especially for a single vaccine, such as the COVID-19 vaccine or also flu vaccine during the flu season, when it can be administered at the time of health care, that really will help to increase uptake.
• 23:06
  SPEAKER_02: So very important for healthcare providers to start those conversations with families, continue them through the hospitalization and also beyond and at discharge.
• 23:16
  SPEAKER_02: And then the same to be said for community physicians and community clinicians, really trying to start the vaccine conversation early on, understanding if there is hesitancy and how we can address that will be really important for increasing uptake.
• 23:32
  SPEAKER_01: Yeah, so taking advantage of the opportunity and to not look for opportunities to avoid vaccination, but rather use every opportunity to encourage vaccination.
• 23:41
  SPEAKER_01: Can you talk a little bit more about hesitancy?
• 23:44
  SPEAKER_01: You talked about asking parents what their concerns are and addressing their concerns.
• 23:49
  SPEAKER_01: Do you have any sort of general recommendations or any thoughts that we can do to try to help mitigate vaccine hesitancy?
• 23:56
  SPEAKER_02: Sure, that's a great question and a challenge.
• 23:59
  SPEAKER_02: I think one of the challenges is that at least it's been very interesting looking at the behavior of parents and also of adolescents and young adults.
• 24:10
  SPEAKER_02: There sort of have been two groups, those who could not wait to get the vaccine and were in line and waited in line as soon as the EUAs for the various age groups were issued, even had a couple situations of people perhaps not stating their actual correct age in order to get vaccinated.
• 24:33
  SPEAKER_02: That was really wonderful to see the embracement by young adolescents and adults.
• 24:40
  SPEAKER_02: And it was also very interesting to observe that a lot of older adolescents actually were very in favor of getting the vaccine when their parents actually might have had some hesitancy.
• 24:50
  SPEAKER_02: So that's a little bit of a different hesitancy discussion when you're addressing the parent's hesitancy, but the child or the adolescent's desire to be vaccinated.
• 25:00
  SPEAKER_02: And then those who have decided that they don't want to get vaccinated, and then that it's really important to understand why and try to address those individual beliefs very carefully.
• 25:14
  SPEAKER_02: And then there are some who would prefer to watch and wait and see what happens after the vaccine is rolled out, and there's some experience with a number of people getting vaccinated.
• 25:26
  SPEAKER_02: I think it is really important for us as hospital endemiologists and infection preventionists to really emphasize that although the vaccine development happened very quickly, there were a tremendous amount of resources, time, effort, investment in the rollout, in the development and the rollout and the initial trials.
• 25:47
  SPEAKER_02: That was really it was an all hands-on-deck approach that we've never seen for any other vaccine or any other therapeutic in our history.
• 25:57
  SPEAKER_02: And so the rapidity at which this happened was actually showed us that it could be done.
• 26:03
  SPEAKER_02: It wasn't, it's really important to emphasize that all the safety concerns were evaluated and also to emphasize to people who might have hesitancy that this is really the most highly studied, these vaccines are the most highly studied vaccines.
• 26:17
  SPEAKER_02: And so the pause with the vaccine, the J and J vaccine related to thrombosis was showed us that our system worked.
• 26:26
  SPEAKER_02: There was a signal and it was looked at that there was a pause in administering vaccines and the evaluation occurred, and it was determined that in perhaps in the subgroup that there was this weight, but vaccine was still safe to administer.
• 26:42
  SPEAKER_02: And so that is something that is really important.
• 26:45
  SPEAKER_02: It shows us that our vaccine safety monitoring systems are working.
• 26:49
  SPEAKER_02: The same can be said for the signal that we've seen with myocarditis and one of the mRNA vaccines.
• 26:56
  SPEAKER_02: It seems to be seems to be an increased incidence of myocarditis and pericarditis in male older adolescents who received one of the mRNA vaccines.
• 27:07
  SPEAKER_02: This is being looked at very, very closely by all of the vaccine safety groups.
• 27:12
  SPEAKER_02: And today, there hasn't been any reason to pause the vaccine, but something that we need to continue to monitor and look at very closely.
• 27:20
  SPEAKER_02: And then finally, I think it's just really important to think about while there may be adverse effects or side effects from these vaccines, we have to remember that the actual disease itself, in many people and some people, we don't really have a good way of predicting which people can be very severe as well.
• 27:40
  SPEAKER_02: And so having some mild side effects after a vaccine that usually resolve within 24 to 48 hours that will protect someone from being hospitalized or worse from having a natural infection really seems like a benefit far, far, far outweighs the risk.
• 27:58
  SPEAKER_01: Thank you very much for that.
• 28:00
  SPEAKER_01: I I think it's striking to me.
• 28:01
  SPEAKER_01: I mean, there's so many pieces about this, but one is as you point out, no corners were cut in this process.
• 28:08
  SPEAKER_01: It was a unified focus on a goal when we came together and achieved it.
• 28:12
  SPEAKER_01: It's what we can do when we really put our minds to it and put aside the differences that keep us from moving forward and work together as a team.
• 28:20
  SPEAKER_01: It's inspiring, if anything, and it's what we try to teach our children.
• 28:23
  SPEAKER_01: And the post-approval surveillance of these vaccines is, I agree, unprecedented and amazing.
• 28:29
  SPEAKER_01: The availability of this data so quickly, but the fact that everything has moved forward so smoothly and so quickly just points out how safe these vaccines are and how they're they're behaving, the effectiveness and the safety of them.
• 28:43
  SPEAKER_01: If there were any hiccups, it would have slowed the process.
• 28:45
  SPEAKER_01: And the process has moved because there just have been very few signals, and the signals we have found we've been able to jump on.
• 28:51
  SPEAKER_01: Like you said, our system is there to pick them up.
• 28:53
  SPEAKER_01: So we talked a little bit about access, and you talked about taking advantage of moments when parents and children are there.
• 28:59
  SPEAKER_01: You know, healthcare disparities are not a new thing, they've been around forever.
• 29:04
  SPEAKER_01: But COVID has really made more of us more acutely aware of access and disparity issues of diversity, equality, and inclusion.
• 29:13
  SPEAKER_01: Can you talk a little bit about that and about pediatric vaccination?
• 29:18
  SPEAKER_01: And what can we do to try to achieve that goal of having all children vaccinated?
• 29:23
  SPEAKER_02: Yeah, so I think that challenge, as you mentioned, that has existed and that of course was exacerbated by the pandemic.
• 29:31
  SPEAKER_02: And I think that what we really need to try to focus on is accessibility.
• 29:36
  SPEAKER_02: And for a number of our families who have not been able to have access to care, really trying to make sure that they do get access to vaccines is extremely important.
• 29:49
  SPEAKER_02: Of course, ideally, every child has a medical home where they can receive their vaccinations and receive their primary care.
• 29:57
  SPEAKER_02: And that is really the ideal that we all strive for.
• 30:00
  SPEAKER_02: But in a lot of situations, unfortunately, that is not achievable.
• 30:04
  SPEAKER_02: And so we have to think about tradition, we have to think about other ways of delivering care other than in a in a medical home.
• 30:13
  SPEAKER_02: Our health departments perform a tremendous service and provide vaccinations and immunizations for children, and that is really a fantastic service.
• 30:21
  SPEAKER_02: Obviously, during the pandemic, they have been many health departments have been really stretched, and some of their routine services, such as immunization and vaccination, have been discontinued just to continue to keep up with all the work related to pandemic response.
• 30:37
  SPEAKER_02: And we've seen that with decreased rates of immunizations and now children requiring catch-up.
• 30:43
  SPEAKER_02: So I think that that's really important.
• 30:45
  SPEAKER_02: We need to make sure that children continue to get their routine vaccinations.
• 30:49
  SPEAKER_02: And then really thinking creatively about how to deliver a vaccine to children.
• 30:54
  SPEAKER_02: You know, I've thought about the ice cream van that goes around the neighborhood, the bells and delivering ice cream.
• 31:01
  SPEAKER_02: It would be great to have a vaccine van doing the same thing.
• 31:05
  SPEAKER_02: And some communities actually have really invested in that in a in a van that were to go and distribute vaccines.
• 31:12
  SPEAKER_02: It's been very successful in older populations who are unable to access transportation and go to a mass vaccination center, for example, but really trying to deliver in the community, thinking about every healthcare encounter as an opportunity to administer a vaccination and make sure that a child is up to date.
• 31:32
  SPEAKER_02: And then also thinking about non-traditional places that children might go to that could be leveraged to give a vaccine.
• 31:40
  SPEAKER_02: And so, for example, uh, grocery stores and also clinics that are affiliated with drug stores, and many of them have been administering vaccines.
• 31:50
  SPEAKER_02: One of the challenges is just working out the age limits and that children can work for providers who are able to actually administer the vaccines at different states and have different age limitations.
• 32:02
  SPEAKER_02: But making vaccines part of something else that someone has to do is really important, as well as taking the vaccine to the person.
• 32:11
  SPEAKER_01: I love the idea of the ice cream truck.
• 32:13
  SPEAKER_01: I mean, I think it would make a great advertisement or TikTok at the very least, if not at work actually as an intervention.
• 32:19
  SPEAKER_01: Kids come running, ah, vaccine, vaccine, vaccine.
• 32:22
  SPEAKER_01: I think that would be awesome.
• 32:24
  SPEAKER_01: But so I love all of these ideas, and I'm hopeful that people and community leaders will do what they typically do, which is how do they get the word out and how do they reach people and how do they connect with folks.
• 32:34
  SPEAKER_01: And so I think, you know, relying on their networks and what they know, we've learned that initially the vaccines and cold chain and storage and all of these things appeared that they were going to be a hindrance.
• 32:44
  SPEAKER_01: But what we've learned is how to expand that and how to work with that and through that.
• 32:49
  SPEAKER_01: And more and more they're becoming more accessible.
• 32:52
  SPEAKER_01: So from an operational point of view, the more we can make the doses of vaccine able to travel and able to survive away from our minus 80s, the more people we should be able to reach.
• 33:02
  SPEAKER_01: So just in wrapping up, any final thoughts that you want to share?
• 33:06
  SPEAKER_01: This has been really, really interesting and I have learned a ton.
• 33:10
  SPEAKER_01: Uh, what what else would you like to leave our folks with?
• 33:13
  SPEAKER_02: So I think, you know, I mentioned it a little bit, but children have not had access to their regular source of care during the pandemic.
• 33:21
  SPEAKER_02: So I think it's extremely important that we um focus on catch-up immunizations and catch-up medical care.
• 33:28
  SPEAKER_02: We saw a number of children who were quite ill because medical care had been deferred due to concerns about pandemic and coming to a medical facility.
• 33:38
  SPEAKER_02: And so everything that we can do to keep our facilities safe so that we can have children coming back into having them routine health care is extremely important.
• 33:48
  SPEAKER_02: And I also think that making sure that people get immunized for influenza for this upcoming season, it's going to be a challenge because thankfully we had no flu season, at least in North America, and that was probably due to a number of different factors, but have to remain vigilant.
• 34:10
  SPEAKER_02: And even though we did not see a large number of influenza infections in the most recent season, we are due for a surge, and so very important to ensure that everybody, especially children, are influenza immunized.
• 34:27
  SPEAKER_02: And then we'll have to just see what happens.
• 34:29
  SPEAKER_02: There's been discussion about requiring a booster for COVID-19 as well.
• 34:34
  SPEAKER_02: So we'll have to see if that comes to fruition.
• 34:36
  SPEAKER_02: I do just have to end with a plea for hand hygiene.
• 34:40
  SPEAKER_02: I think that we can't say that enough.
• 34:43
  SPEAKER_02: Something is just so basic, sort of forget about it, but it's so important.
• 34:48
  SPEAKER_02: And I'm really focusing on making sure that children, especially who love to get into everything, wash their hands very frequently.
• 34:56
  SPEAKER_01: Yes, I agree.
• 34:57
  SPEAKER_01: I think I'm very hopeful that one of the skills that this generation comes away with is frequent hand hygiene.
• 35:03
  SPEAKER_01: I also really like how you're focusing on all vaccines.
• 35:06
  SPEAKER_01: So, you know, bringing it back to medical homes.
• 35:08
  SPEAKER_01: So, yes, COVID vaccine is extremely important, but a medical home provides so much more than just vaccines to families and to children from a holistic point of view.
• 35:17
  SPEAKER_01: And so if we look at COVID-19 or COVID-19 vaccine as a way to connect with a medical home, the children and the families will only benefit from that.
• 35:26
  SPEAKER_01: So I really appreciate you saying that.
• 35:28
  SPEAKER_01: Thank you very much to Dr.
• 35:29
  SPEAKER_01: Shane for sharing her perspectives and experiences.
• 35:33
  SPEAKER_01: This podcast can be accessed on Shay's online education center, Learning CE, under the Rapid Response Program.
• 35:41
  SPEAKER_01: You'll also find other resources which include recorded webinars such as the SHA COVID 19 town halls.
• 35:48
  SPEAKER_01: This concludes today's episode of the Rapid Response Podcast.
• 35:52
  SPEAKER_01: Thank you for tuning in.