5 August 2021

Since the start of the pandemic, parents and carers have been able to draw some comfort in the fact that children represented only a small proportion of COVID-19 cases worldwide. However, the Delta strain, which has become the dominant strain in many countries, is increasingly infecting children and young people in numbers that may challenge the idea that the youngest members of society face minimal risk from COVID-19. And if that’s no longer the case, what does that mean for schools as we enter this next phase of our new normal? How much do we know about the risks of vaccination in children?  Here’s a breakdown of the current facts and expert advice about COVID-19, vaccination and children:

How many kids have been sick so far?

While children do catch the SARS-CoV-2 virus which causes COVID-19, the data internationally has consistently reported the lowest rates are in children. Pre-school and primary school age children in particular appear less likely to acquire the infection and make up less than 5% of reported cases in Australia and elsewhere.

“Importantly, the published data also suggests that children tend to have less severe cases of COVID-19 than adults,” says Children’s Health Queensland Director of Infectious Diseases Julia Clark. “In most cases the virus causes mild or moderate symptoms, which can include fever and cough, but also milder cases of pneumonia sometimes requiring hospitalisation.”

“Severe complications in children are uncommon,” Dr Clark adds.

Serious illness remains extremely rare in children. While there are reports of higher rates of child deaths in some countries, a population-based analysis of 12 million children in the UK in 2020 found 1 in 50,000 children experienced a critical illness, and the rate of death related to COVID-19 was 2 per million children. In comparison, about one half of all adults with critical illness (predominantly elderly people with chronic conditions) have died.

Are children and young people more at risk of infection with the Delta variant?

The Delta variant is a clearly more transmissible virus than the original form of the virus, or indeed the UK (Alpha) variants before it. It has rapidly spread to become the dominant strain in many parts of the world. This strain is more infectious to all, but there is no evidence as yet to suggest it affects children any differently. The highest rates of infection with the Delta variant have been seen in adolescents and young adults, but these are the groups with the lowest rates of vaccination, and with the most social mixing. In the UK, outbreaks in schools have been reported more commonly with the Delta variant, but these infections appear to follow rates of infection in the community. The majority of transmission still occurs in the household. Infection rates in young children remain lower than other age groups despite the absence of vaccination.

Is the delta strain more dangerous for children and young people?

There is no evidence that Delta variant causes more serious illness in children specifically Reassuringly data from the UK suggests admission rates for children have not increased despite emerging reports across the world that admission to hospital may be increased in young adults compared to previous variants. The good news is the vast majority of children with the Delta variant continue to experience a mild infection. Severe infections in children requiring intensive care unit admission or leading to death remain surprisingly uncommon throughout the pandemic.

Are infants more at risk?

The latest published data suggests infants are at an increased risk of developing severe cases of COVID-19 compared to young children, but with a similar risk to adolescents. Approximately 10% of babies appear to need admission to hospital to receive oxygen, in a similar way to other winter viruses. These are important and serious infections, but these babies almost all recover without needing support from intensive care. This is very different to the experience in the elderly, particularly those with existing health problems.

What about children with complex and chronic conditions?

Internationally, data from the first 3 waves of the global pandemic continues to show that children are affected less commonly and less severely than adults by COVID-19. “Even children with serious underlying conditions will mostly only experience a mild illness with COVID-19. This is reinforced by data from liver transplant units and from children’s cancer centres,” Dr Clark said.

That said, most children who have experienced severe cases of COVID-19 to date have had underlying chronic conditions, with chronic pulmonary disease, obesity, neurological and developmental conditions, and cardiovascular conditions the most frequently reported internationally.

“It’s important to note that most children who are infected with COVID-19 have become infected via a family member. It is therefore crucial for every family member to take the recommended infection prevention precautions and to ensure eligible family members are vaccinated to reduce the risk to a child with a complex and/or chronic condition getting the disease.”

Parents and carers should contact their child’s specialist care team for tailored advice and information about their specific condition.

Visit our dedicated COVID-19 page for further health advice for children with complex and chronic conditions.

What about children who are immunocompromised?

Children whose immune systems have been compromised due to medical treatment (such as chemotherapy, organ transplants, current use of immunosuppressive medications etc) are more at risk from the common cold, the flu and other infections, and are more at risk of developing a serious infection from COVID-19. Most children with cancer experience mild illness and do well if they get COVID-19 but more severe illness can occur, so close observation is needed.

It’s always important to take precautions to prevent the spread of infections for immunocompromised children (including basic hand and respiratory hygiene practices, and social distancing). Having vaccinated carers and other close contacts is also essential. If you have concerns about your child, we recommend discussing their current level of immunosuppression with their specialist to form the best plan for your child.

Visit our dedicated COVID-19 page for further health advice for children who are immunocompromised or immunosuppressed.

What about the multi-inflammatory syndrome?

One of the most severe presentations of COVID-19 is a complex multi-system inflammatory condition terms Paediatric Multisystem Inflammatory Syndrome – Temporally Associated with SARS-CoV-2 (or PIMS-TS). It has some features that are similar to other rare auto-inflammation diseases, such as Kawasaki disease. Doctors from around the world don’t know why a very small number of children develop this condition when most other children are not affected. This is an extremely uncommon disease and most children who have developed the condition, including critically ill children, have all made a good recovery.

Are children ‘super-spreaders’ of the coronavirus?

While we all know kids, especially younger ones, are not great at keeping their hands and bodily fluids to themselves at the best of times, there is so far no evidence to suggest they are so-called super-spreaders of coronavirus (COVID-19). Infection rates in children, including in schools, appear to mirror community rates of transmission rather than driving them. Outbreaks within schools and children’s camps are increasingly being reported with the Delta variant, but the vast majority of infections in children still occur in the household.

All the evidence that we have seen so far suggests that children, with mild or asymptomatic (showing no signs or symptoms) infections are not very effective spreaders of the virus. However, the Delta variant is highly transmissible, and we are yet to see the impact of this on children who are so far unvaccinated. Of course, this risk can be reduced even further with careful attention to hand hygiene and cleaning, particularly in children who may have symptoms.

Is the COVID 19 vaccine safe for children?

Research from the United States supports the safety of the Pfizer vaccine in children over the age of 12. A trial of more than 2,200 adolescents showed the vaccine was safe and effective in reducing infections, and produced a detectable immune response.

All people aged 12 and over are now eligible for a COVID-19 vaccine. The Australian Technical Advisory Group on Immunisation (ATAGI) recommends the Comirnaty (Pfizer) or Spikevax (Moderna) vaccine for people 12 years and older. Read the ATAGI recommendations on the use of COVID-19 vaccines in all young adolescents in Australia.

Children under 12 years are not currently eligible for a COVID-19 vaccine in Australia, however international trials are under way. Access to COVID-19 vaccines for children under 12 years will require approval by the Therapeutic Goods Administration (TGA).

Further information about COVID-19 vaccines and the national rollout is available on the Australian Government Department of Health and Queensland Health websites.

How can I help prevent my child getting COVID-19?

The single most effective tool available to prevent infection in children is to reduce infections in adults. Countries around the world have demonstrated the effectiveness of vaccination in achieving this. Young children who cannot receive a vaccine are protected by the vaccination of adults around them.

Additionally, physical distancing, good hand and respiratory hygiene are all important preventative actions we can take to prevent COVID-19 infection.

Teach your children to:

  • Wash their hands with soap and water often and thoroughly (for at least 20 seconds) to prevent viruses entering their body. This includes after being out in public, before eating, and after going to the toilet.
  • Cough or sneeze into a tissue or their elbow (and wash their hands and put the tissue in the bin afterwards).
  • Try not to touch their face.

Try to stay at least 1.5 metres away from people who are coughing or sneezing. (Even if they don’t have COVID-19, they might have germs you don’t want any way!).

Don’t let fear put your child’s health at risk

If your child is feeling unwell and you think they need to be seen by a doctor, especially in an emergency, there is no need to be concerned about the risk of them picking up COVID-19 in a hospital, practice or other healthcare facility. Strict infection control measures (including personal protective equipment like masks and gowns, intensive cleaning routines and isolation procedures) are in place to protect everyone – children, families and staff. If your child requires urgent care or has an important procedure or treatment due, do not delay bringing them to hospital. Similarly, if your child is on prescribed medication as part of their treatment or homecare, it is important that they continue taking their medication.

Be assured, the paediatric medical community is working tirelessly to ensure that all children with acute and/or chronic conditions are treated effectively and safely.

What should I do if my child develops symptoms of COVID-19?

If your child develops any COVID-19 symptoms, particularly fever, cough, sore throat or shortness of breath, loss of smell or taste, they should be tested.

Children may also experience other symptoms, such as runny nose, headache, loss of smell, loss of taste, nausea or vomiting, muscle pain, joint pain, fatigue, diarrhoea or a loss of appetite. Symptoms can vary depending on each case.

If your child has any symptoms, you can visit your nearest COVID-19 testing centre or ‘fever clinic’.

If you are unsure, or if your child has a sudden onset of any COVID-19 symptoms, you should contact your local doctor or
call 134 COVID (134 268) for health advice.

You should also keep your child isolated until their symptoms have cleared up.

If you think they need to see a doctor, you should go to the GP or local emergency department. Remember to phone ahead so the practice or emergency department can make appropriate safety preparations and protect other patients.

It’s important that you don’t delay taking your child to hospital if they are sick.