New evidence based advice for primary care from the IPCRG IQ&A service:
· Vaccination of children and adolescents against SARS-CoV-2
· Benefits of doses of the SARS-CoV-2 vaccines beyond the initial vaccination
· Transmissibility of the Delta variant from and to people who are vaccinated against SARS-CoV-2
· Should flu vaccination be recommended alongside a COVID booster vaccine
The IPCRG's QandA service has released new answers to provide our primary care colleagues providing usable, quickly absorbed advice for primary care physicians. The 24 published answers are all openly available on the IPCRG website and are reviewed and updated regularly. These answers address key questions raised by our Sentinel Network. This time we would like to highlight four recent answers:
Vaccination of children and adolescents against SARS-CoV-2
Vaccinations are now being provided in many countries. 18 phase 1 to 3 studies of various SARS-CoV-2 vaccines are listed in clinicaltrials.gov in children and adolescents with completion dates ranging from 2021 to 2025.
Children <12 years: While for most healthy children <12 years of age COVID-19 is a mild disease, new variants could change this. Evidence for reduced transmission is likely needed to justify vaccination. The role of children in spreading the virus is unclear, with conflicting results from epidemiologic trials.
Adolescents (12-18 years):& New data suggests that adolescents are at increased risk for severe COVID-19 disease compared with children <12 years of age (CDC 2021). Many countries have initiated vaccination programmes for healthy adolescents >12 years of age.
· Parents can be advised that the data suggest the vaccines available for use in those aged 12-18 years of age are safe and side effects are mild
· The risk of serious side effects is seen to be small, but more data will emerge
· Should SARS-CoV-2 variants cause more severe illness in those aged <18 years of age, the benefits of vaccination may outweigh associated risks
Benefits of doses of the SARS-CoV-2 vaccines beyond the initial vaccination
Protection against severe COVID-19 illness from current SARS-CoV-2 vaccines appears to begin to wane after 6 months, so an additional dose may be needed. Early results indicate a robust immune response following vaccine booster doses. In the UK, adults considered at high risk for severe COVID-19 illness will be prioritised for booster vaccination.
· Some country policies currently deviate from WHO advice about avoiding vaccine inequity and the need to increase primary global vaccination coverage before boosting
· Booster programs where initiated should ideally be at or near 6 months since the last primary dose
Transmissibility of the Delta variant from and to people who are vaccinated against SARS-CoV-2
The transmission rate of the SARS-CoV-2 Delta variant is higher than that of the Alpha variant, regardless of vaccination status. The Pfizer-BioNTech vaccine provides around 79% protection from infection 7-14 days after the 2nd dose. The Oxford-AstraZenneca vaccine provides around 60% protection from infection 14 days after the 2nd dose. The Delta variant has a viral load around 1000 times higher than that of the initial strains.
· Fully vaccinated individuals may still and transmit the SARS-CoV-2 virus
· Infection control measures still need to be used when in contact with patients
· Continue to deliver full vaccination courses against SARS-CoV-2
· Advise patients of the potential for viral transmission even after full vaccination
Should flu vaccination be recommended alongside a COVID booster vaccine
Coinfection with influenza and SARS-CoV-2 is associated with an increased risk of severe disease and adverse outcomes. Influenza vaccination has been shown to improve outcomes.
Studies are ongoing to evaluate the effectiveness and safety of delivering SARS-CoV-2 and influenza vaccinations at the same time, although initial results are positive.
· Continue vaccination against influenza and SARS-CoV-2 according to guidelines.
· There is currently no evidence to suggest that giving flu and SARS-CoV-2 (first or second dose) vaccines on the same day or 7 days apart is associated with reduced effectiveness or increased risk for side effects, however waiting 7 days is a reasonable precautionary measure that allows monitoring and management of the common side effects
· High prevalence of either infection in the population might mean a more rapid dual approach is required
The IPCRG QandA service answers questions from our Sentinel Network of globally based front line clinicians. If you would like to join this network and contribute to our questions, you can do so via the simple form on our QandA homepage.
HIFA profile: Neil Fitch is a Research Project Manager for the International Primary Care Respiratory Group, and is based in Belgium. Professional interests: Respiratory disease; COVID-19; Advice and information; Project management. neilfitch100 AT gmail.com