Offer of coronavirus immunisation for children and adolescents expanded
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Following a recommendation from the Norwegian Institute of Public Health, the Government has decided to offer coronavirus vaccines to children aged 5–11 and a second dose to 12–15-year-olds.
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In their assessment, the Norwegian Institute of Public Health has emphasised that coronavirus vaccines can have a positive benefit. However, the risk of a severe disease course at this age is small, and the need for vaccines for children and adolescents is limited.
The Norwegian Institute of Public Health nevertheless believes that it is appropriate that vaccinations can be given to those who wish to take them. It is also pointed out that immunity following infection can provide broad and lasting protection among children and adolescents. From September 2021, 12–15-year-olds have been offered coronavirus vaccination. Children aged 5–11 years with severe underlying conditions have been offered the vaccine since December.
Vaccination offer can be expanded
After a thorough assessment, the Norwegian Institute of Public Health has advised the government that the vaccination offer can be extended to:
Children and adolescents belonging to cohorts 2006–2009 who have currently only been offered one vaccine dose, can be vaccinated with a second vaccine dose if they and their parents so wish.
Children in the cohort 2016–2010, and those in the cohort 2017 who have reached the age of 5, can be vaccinated if their parents so wish. The offer is most relevant for children with chronic diseases, children in contact with vulnerable people, and children who will stay or move to countries with a high risk of transmission or poorer access to health services.
Low risk of severe disease course
The Norwegian Institute of Public Health points out that the risk of a severe disease course, which can lead to admission to hospital, is low in these age groups. The low risk for the individual child and adolescent has made the assessments difficult.
“12–15-year-olds already have high protection against a severe disease course after the first vaccine dose. Although there is a small additional benefit from further doses, we have weighed this against the risk of myocarditis, a rare but serious side effect,” says Margrethe Greve-Isdahl, Senior Physician at the Norwegian Institute of Public Health.
In the assessments, the benefit (effect of vaccination) for the individual and for society is assessed in relation to the risk of serious side effects. In addition, it has been considered whether having the disease as a child can be beneficial to the immune system in the long term. Greve-Isdahl emphasises that immunity following infection, with or without a single dose of vaccine, can also provide broad and lasting protection among children and adolescents.
“There is no doubt that the vaccines can provide protection against a severe disease course among children too, but the protection against transmission is poorer, especially with omicron. We have seen from Norwegian data that recovery from infection in adolescents can provide very good protection against new infections, and it may therefore be an advantage for protection against new virus variants in the future. Therefore, we have advised the government that vaccination of children and other doses to adolescents should be an individual choice, and not a strong recommendation from the authorities,” says Greve-Isdahl.
Social benefits are not weighed as heavily as individual benefits
The societal benefit of vaccinating children has been assessed, but is not weighed as heavily as the individual benefit for children. The importance of vaccinating the entire child population against coronavirus is small when the infection is still transmitted among vaccinated people. Vaccination of children and other doses to 12–15-year-olds can have an effect on transmission, but with omicron, the effect is short-lived and limited. Greve-Isdahl emphasises that this assessment may differ between countries; each country must assess the outbreak situation and risk factors in their population.
"In Norway, we are in a fortunate situation with high vaccination coverage among adults, which limits hospital admissions even though there is transmission among children and adolescents. In addition, we have accessible and equal health services for everyone, so access to health care is not a problem here. In some countries, unequal health care access can be an independent argument for vaccinating children. The societal benefit of vaccinating an entire child population where there is little admission to hospital is therefore limited in Norway," says Greve-Isdahl.
The Norwegian Institute of Public Health is now working with information to the municipalities on how the offer can be organised, in addition to specially adapted information material. The child vaccine doses will be sent to the municipalities at the end of January 2022. Adolescents aged 12–15 years will receive the same vaccine dose as adults, and will have the opportunity to be vaccinated in their municipality when this is practically possible. Information will be available on each municipality's website.