VACCINATING CHILDREN AND PREGNANT, LACTATING WOMEN
WHY IN NEWS?
Over four months after the COVID-19 vaccination drive was launched, India has administered around 19 crore
doses of Covishield and Covaxin so far. But it is yet to open up vaccination for pregnant women and children.
On May 19, the Union Ministry of Health and Family Welfare accepted fresh recommendations from the National Expert Group on Vaccine Administration for COVID-19 (NEGVAC) for vaccinating lactating mothers.
The country is yet to study the safety and efficacy of the two existing vaccines in the paediatric population, with the Drugs Controller General of India recently giving the nod to Bharat Biotech to conduct clinical trials of Covaxin in the 2-18 years age group.
WHY SHOULD PREGNANT AND LACTATING WOMEN BE VACCINATED AGAINST COVID-19?
“Vaccinating pregnant women against COVID-19 is extremely important. The second wave is worse than the first wave.
Roughly one in three pregnant women tested positive for COVID-19. “This is a high number, and it is important to do something to protect them as the disease burden in pregnancy is high,” she said.
The Federation of Obstetric and Gynaecological Societies of India (FOGSI), in a statement, said protection should be extended to pregnant and lactating women. “The very real benefits of vaccinating pregnant and lactating women seem to far outweigh any theoretical and remote risks of vaccination.”
For lactating women, FOGSI stated that there were no known adverse effects on neonates who are breastfeeding. “In fact, there is a passage of protective antibodies to the child, which may be a beneficial effect.”
DO WE HAVE DATA TO ASSESS THE RISKS OR BENEFITS?
According to the World Health Organization, while pregnancy brings a higher risk of severe COVID-19, at present, very little data is available to assess vaccine safety in pregnancy. There is no evidence that suggests vaccination would cause harm during pregnancy.
“To date, none of the clinical trials have included pregnant and lactating women for obvious reasons as no ethics board will give the nod.
Preliminary information from the United States, which has been vaccinating since last year, is that the immune response has been good in pregnant women, irrespective of the type of vaccines. Antibodies were found in the umbilical cord and breast milk that could give protection for the new-born.
CAN CHILDREN BE VACCINATED?
Across the globe, several studies have begun to examine the safety and efficacy of COVID-19 vaccines in children.
The United States has started vaccination for children above 12 years of age.
Since adults are either infected or vaccinated, children will become vulnerable in the next wave. Initially, it was thought that children will not be affected due to the absence of ACE2 receptor in the lungs but we do see several children with the infection, who are mostly asymptomatic, and some with typical symptoms of COVID-19.
There are two ways that COVID-19 presents in children — as viral fever and as a multisystem inflammatory syndrome. Vaccinating children against COVID-19, therefore, becomes necessary.”
HOW IS IT DIFFERENT FROM VACCINATING ADULTS?
When a vaccine against COVID-19 for children is being developed, the vaccine developer should keep in mind the effect of the vaccine on children, and how safe the vaccines are in children.
The benefits should outweigh the risks to a great extent. There should be sufficient safety trials before rolling out the vaccines for children.
The results of trials abroad among 12-year- to 17-year-olds have demonstrated the safety of vaccines.
WHAT LIES AHEAD?
Vaccination of pregnant women is something that needs immediate attention.
There are a lot of debates on the safety of vaccines in pregnancy. “Being a killed vaccine, there is no real expectation of adverse effects with Covaxin.
There have been some reports of coagulation and blood clotting problems with Covishield, especially in the younger population less than 30 years of age.
Noting that there was only a theoretical risk of adverse events, she said informed consent could be obtained from women before vaccination.
“Usually, vaccines are avoided in the first 12 to 13 weeks of pregnancy due to organogenesis. Vaccines, including the flu shot, are generally given after 26 weeks to protect the neonates, too. But this is a pandemic, and we could give the vaccination at any time during the pregnancy to protect the mother.”
“Once we have a vaccine for children, we should look at how it can be included in the vaccination schedule without interfering with the regular schedule. Coronavirus is highly mutated, and so, like influenza, children may need regular booster doses.”