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Children’s version of COVID vaccination calculator released


Morgan Liotta


14/03/2023 3:49:18 PM

While vaccine coverage for 5–11-year-olds remains low, the updated CoRiCal tool could help boost uptake among the cohort.

Child getting vaccine
The updated CoRiCal tool for children is aimed to provide ‘a stable and reliable stream of information’ around vaccination.

To help address vaccine hesitancy and boost vaccination rates, the Immunisation Coalition launched its COVID-19 Risk Calculator (CoRiCal) in October 2021.
 
It worked to support adults in making an informed choice based on their current circumstances by presenting the risks and benefits of the vaccines on offer.
 
Fast forward 18 months and there is now a children’s version of CoRiCal available, with the update helping parents to make the risk-benefit assessment for their children’s circumstances.
 
The latest update to the online tool builds on a collaboration between the Immunisation Coalition, the University of Queensland (UQ), Queensland University of Technology, Sydney University and Flinders University, with the aim to better inform parents on vaccination with access to the latest information and in turn, help to boost vaccination rates among the paediatric cohort.
 
CoRiCal co-lead, Flinders University Associate Professor John Litt told newsGP he expects the updated tool will also provide GPs with better support.
 
‘It should save GPs some time, as many patients could look at it before seeing the GP,’ he said.
 
‘Also, it will help the GP and parent to focus on what might worry them about the vaccine. It is a decision-making tool, so the final decision is made by the parent.’
 
With the winter months approaching and children’s COVID vaccine coverage across Australia remaining ‘static’, Associate Professor Litt said the updated tool comes at an important time.
 
‘In particular, we’ve observed a very low vaccine uptake in children aged 5–11, with only a 10% increase in the last six months,’ he said.
 
The Department of Health and Aged Care’s national immunisation coverage for five-year-olds missed the target of 95% for the December 2022 quarterly report.
COVID-19 vaccination coverage rates from September 2022 show that 51.3% of children aged 5–11 had received their first dose, and 40.4% their second.
 
Anxiety about potential adverse events, especially for ‘relatively new’ COVID-19 vaccines, may lead to hesitancy to receive first or subsequent doses, according to Associate Professor Litt, who said CoRiCal should help to ease these concerns.
 
‘It is … crucial that decisions are informed by transparent risk-benefit analysis and effective risk communication, ensuring higher vaccine uptake in children – especially as we enter the winter months,’ he said.
 
‘We hope the CoRiCal tool for children will provide a stable and reliable stream of information, without the risk of being misinformed or misled.’
 
UQ virologist and CoRiCal co-lead Dr Kirsty Short agrees.
 
She says a significant challenge for parents and healthcare providers since the rollout of COVID-19 vaccines has been a lack of access to the latest evidence regarding risks versus benefits, or illness and deaths prevented, in children.
 
‘There is a lot of misinformation online about COVID-19 and vaccinations, so this calculator plays a critical role by providing tailored, evidence-based information in a convenient way,’ Dr Short said.
 
Meanwhile, Associate Professor Litt noted that the updated calculator also provides reassurance around the ‘feared adverse effect’ of myocarditis, with evidence that it is much lower following an mRNA COVID vaccine than after getting COVID.
 
‘Given that more than 60% of children have had COVID, giving the COVID vaccine will enhance their immunity and provide protection for children that haven’t had COVID,’ he said.
 
The updated risk calculations on CoRiCal are based on a framework that allows researchers to update information as new evidence becomes available.
 
Lead designer, infectious diseases registrar Dr Tej Shukla, said the tool ‘streamlines and summarises large amounts of information and stores it in one reliable place’.
 
The March 2023 CoRiCal update adds to previous data additions to the online calculator, including benefits of booster shots and risk of death from the Omicron variant, and myocarditis risk from COVID vaccines.

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Dr Brendan Leslie   15/03/2023 10:08:30 PM

"...giving the COVID vaccine will enhance their immunity and provide protection for children that haven’t had COVID,’ he said.''

I am not aware of any evidence that covid vaccines reduce transmission of omicron (as opposed to the ancestral strain) particularly in children but I am happy to be corrected with scientific evidence otherwise.

I am also not aware of evidence that vaccines result in a decrease in the chances of a child catching omicron. If this is correct, then comparing myocarditis rates due to the disease versus the vaccine may be redundant.

Why do children who have already had covid need their immunity 'enhanced'? Are hospitals seeing otherwise healthy children hospitalised with covid the second time they catch it? Is there even a single case report of this happening?

I would also like to hear an evidence based answer to a hypothetical situation where a completely well six year old who has already had covid can only have either a covid vaccine or a men b vaccine.


A.Prof John Charles B Litt   20/03/2023 12:29:58 PM

I have re-entered the questions posed and have responded under each. Here is Q1
1. I am not aware of any evidence that covid vaccines reduce transmission of omicron (as opposed to the ancestral strain) particularly in children

We agree that protection against transmission is both limited and brief. WHO indicate that, during the current Omicron dominant period, vaccine impact on transmission is only modest and short-lived.
A recent Nature Medicine article concurred: ‘researchers agree that vaccinating kids has a small and short-lived effect on reducing community transmission’ Mallapaty Nature | Vol 610 | 13 October 2022.
A significant benefit of COVID vaccination in children is the protection against severe disease including MIS-C (Nathanielsz https://pubmed.ncbi.nlm.nih.gov/35970935/ ) and reduced risk of hospitalisation as demonstrated in the CoRiCAL output graphs.


A.Prof John Charles B Litt   20/03/2023 12:32:53 PM

I have re-entered the questions posed and have responded under each. Here is Q2.
I am also not aware of evidence that vaccines result in a decrease in the chances of a child catching omicron.
A study was conducted from January 21, 2022, through April 8, 2022, when the Omicron variant was spreading rapidly, where the data on children in Singapore aged 5 to 11 years were analysed. The study showed that the vaccine effectiveness against PCR-confirmed SARS-CoV-2 infections was 65.3% (95% CI, 62.0 to 68.3) among children 5 to 11 years of age during the omicron wave (Tan NEJM 2022 https://pubmed.ncbi.nlm.nih.gov/35857701/ ) .
This is demonstrated in the Calculator where one of the charts highlights the risk of COVID due to the Omicron variant with no vaccine versus two doses. It is lower after getting 2 doses of the Pfizer COVID vaccine.
We also believe that it is also important to consider other factors that contribute to COVID risk.


A.Prof John Charles B Litt   20/03/2023 4:58:26 PM

3. Why do children who have already had covid need their immunity 'enhanced'?

There is evidence, in adults, that hybrid immunity provides a higher level of protection against reinfection, hospitalisation and severe disease than immunity from SARS-CoV-2 infection alone. (Bobrovitz Lancet Infect Dis. 2023 https://pubmed.ncbi.nlm.nih.gov/36681084/ ) Data about hybrid immunity in children is limited, however a prepublication study from UK found a marked increase in antibody response to all variants from vaccination following primary Omicron infection (Dowell BioRxiv 2022, 501570. doi: 10.1101/2022.07.26.501570).


A.Prof John Charles B Litt   20/03/2023 4:59:04 PM

4. Does vaccination against COVID reduce hospitalisations?

Yes but COVID vaccination has a lower vaccine effectiveness against Omicron than other COVID variants (Li J Infect https://pubmed.ncbi.nlm.nih.gov/36621642 : Paul Hum Vaccin Immunother https://pubmed.ncbi.nlm.nih.gov/36915960/ ). In a systematic review the Pfizer vaccine effectiveness against hospitalisation due to Omicron COVID in children was 46% (qv Paul).

While getting Omicron provides some protection against subsequent reinfection with COVID, this is reduced to 51% by five months following the initial bout of COVID (Lin NEJM https://pubmed.ncbi.nlm.nih.gov/36069811/. By comparison, the vaccine effectiveness against subsequent Omicron COVID is 60% at five months (qv Lin).


A.Prof John Charles B Litt   20/03/2023 4:59:25 PM

5. Do ‘healthy’ children get hospitalised due to Omicron COVID?

Healthy children can get hospitalised due to Omicron COVID ( Schober. BMJ Paediatr Open. 2022 https://pubmed.ncbi.nlm.nih.gov/36053578/ ; Shi. MMWR Morb Mortal Wkly Rep. 2022 https://pubmed.ncbi.nlm.nih.gov/35446827/ ). SARS-COV-2 strains prior to Omicron – 53% of children had no comorbidities (qv Schober). The proportion of hospitalisations from Omicron COVID in children with no comorbidities was 30% (qv Shi).


A.Prof John Charles B Litt   20/03/2023 4:59:48 PM

6. Are hospitals seeing otherwise healthy children hospitalised with covid the second time they catch it?

This is uncommon and more likely in children who have co-morbidities. Evidence around level and duration of protection following SARS-CoV-2 infection in children is variable and focuses on the immunological response post infection, particularly post Delta (Buonosenso Front Immunol. 2023 https://pubmed.ncbi.nlm.nih.gov/36713374/ ). One study found a weak humoral response following Omicron in children, suggesting possible poor protection against reinfection (qv Dowell 2022).


A.Prof John Charles B Litt   20/03/2023 5:06:50 PM

7. What about the hypothetical situation where a completely well six-year-old who has already had covid can only have either a covid vaccine or a men b vaccine.

We believe that the comparison is better framed when you have identified the potential risks of both diseases. Considerations include risk of infection with meningococcal B and risk of invasive meningococcal B infection (eg level of circulating disease, age of child, social behaviours and circumstances such as overcrowding or smoking in the household, ATSI child, or other First Nations background, underlying health versus risk of COVID infection and then risk of severe disease for each infection.
The data we provide is based on population studies and show the results based on age group and sex. When considering risk for an individual, there needs to be a discussion taking into account the specific situation, risks and benefits. See https://corical.immunisationcoalition.org.au/children