Overview: COVID-19 Vaccination & Info Session for children with additional needs and disabilities

To vaccinate or not? Which vaccine is the safest? How many doses? Vaccination for children has become one of the hottest topics in Hong Kong ever since the Government opened up booking slots from February 2022 onwards. Having the up-to-date facts and scientific evidence is critical in helping parents make an informed decision, particularly for parents of children with disabilities or additional needs.

On Sunday 13 March 2022, we were delighted to host a briefing from paediatric neurologist Dr Karen Yam Kwan Ming, Associate Consultant, Department of Paediatrics at Prince of Wales Hospital and Honorary Clinical Assistant Professor, Department of Paediatrics at the Chinese University of Hong Kong. The talk was held in collaboration with the Child Development Centre (CDC), and CDC Executive Committee Member and SNNHK parent Cruzanne Macalligan introduced the session.

Current situation in Hong Kong

Dr Yam explained that Hong Kong is currently undergoing its 5th wave of infections with COVID-19, and the majority of cases are Omicron, which is highly contagious and transmissible. The number of people infected can double in 2-3 days and the incubation period is 2-7 days, with symptoms showing up in under 3 days. The most common symptoms are a sore throat, body aches, and loss of tase of smell.

The Omicron variant can cause severe illness in the elderly, immunocompromised, or those with chronic illnesses, and it is suspected to have a higher risk for children, with 7 child fatalities reported in Hong Kong to date. More than 50,000 cases per day were reported in early March. In all cases, it has been proven that vaccination reduces the risk of severe disease.

How safe are the vaccines?

Dr Yam explained how vaccines work by safely mimicking infection and providing immunity against future infection, like a “training exercise” for your body. There are two vaccines available in Hong Kong, namely Pfizer-BioNTech (approved by FDA for children aged five and older) and Sinovac (approved for children aged three and older).

The BioNTech vaccine (brand name Comirnaty) has a very high efficacy rate of up to 100% in adolescents and has proven to lower the risk of hospitalisation by 93% in children aged 5-11years old. But how safe is it? Dr Yam noted that some children had some local-site redness and pain after vaccination, but very little to no side effects or hypersensitivity. For adolescents, there were some cases of chest pain and myocarditis but they almost all recovered without any long-term complications. For Sinovac (brand name CoronaVac), data from Brazil and Indonesia also shows high efficacy and, despite a surge in cases, the number of deaths drops rapidly for those who have been vaccinated. For children having had Sinovac, their antibody production is more than 96%. No serious adverse side effects have been noted with Sinovac.

As the COVID-19 vaccination is still relatively new, there is not yet any long-term safety data available on the vaccines. What the medical community does know for sure is that there are very concerning “Long COVID” effects. Some 3-15% of children who had COVID-19 have persistent symptoms after four weeks, and 50% of children who have had COVID-19 have at least one prevailing symptom after 17 weeks.

What if my child has other health problems?

We have all heard of people saying that they could not get the vaccine “because of high blood pressure”. Is this a valid reason? Despite perceptions to the contrary, Dr Yam confirmed it is safe to get the vaccination, even if you have diabetes, hypertension, asthma, G6PD deficiency, high cholesterol, undergoing kidney dialysis, etc.

Likewise, if you have a child with epilepsy, you can be reassured that they do not have a higher risk of side effects, and those children who suffer from seizures triggered by fever should not avoid getting the vaccine. Dr Yam recommended that parents can research the ways to reduce the likelihood of fever caused by a vaccine, and have a seizure action plan ready.

How many doses? The current recommendation is two primary vaccinations, followed by a booster to keep antibody levels up. For children aged 3-17 taking Sinovac, the recommendation is two doses, 28 days apart, plus a booster for children ages 12+ or immunocompromised patients. Children taking BioNTech should have two doses, eight weeks apart, and a booster is recommended for those aged 12+ or immunocompromised patients. The paediatric preparation of BioNTech is not available in Hong Kong so children get 1/3 of the adult vaccine dose. The active ingredients are the same, it is just that the solvents are a little bit different.

What happens if your child gets Omicron?

The most common symptoms are a fever, runny nose, or a cough, and most children will recover in about seven days. Usually, they won’t require antiviral drugs. Omicron can also affect the brain, heart, gut, airway and lungs (parents should watch out for croup/ barking cough).

Warning signs of more severe illness include a persistent fever, breathing difficulties, blue lips, chest pain or fast heartbeat, a sudden change in awareness or confusion, convulsion, or a persistent inability to eat or vomit. If the child is lethargic and not showing an interest in playing games or an iPad, this can be another warning sign.

A useful joint statement by various HK paediatric heath experts recommends the following actions for parents:

1. record the onset date;

2. regular observation, including body temperature;

3. record oral intake and monitor output (urine and bowel movements);

4. be aware of new symptoms such as vomiting;

5. be highly alert to a deterioration in symptoms, eg, pallor, difficulty breathing.

At the hospital: The vaccination process

Dr Yam recommended learning about the procedures and explaining to your child what will happen. Medical experts don’t recommend pre-medications and you should wear loose, comfortable clothing. Sinovac is administered to children in the arm, while BioNTech is given in the thigh. Children should avoid strenuous exercise for a week after vaccination.

Playright has good pamphlets to prepare children about the process (Sinovac / BioNTech). There are also videos produced by Playright in which a hospital play specialist explains to children about the COVID-19 vaccination (available in Cantonese with English subtitles) to prepare your children before receiving vaccination. You will be waiting for a while and the nurse will explain what is going to happen, then you have a cold alcohol swab, then the vaccination. You have to wait for 15 minutes to ensure no side effects.

You can do breathing exercises with your child to help ease tension, and also play some games. SNNHK parents with experience of taking their child for vaccination recommended speaking to the staff in advance to explain your child may need additional accommodations and taking earphones to block out background noise, including from other children who might be upset. At some hospitals such as Gleneagles, they may even get a balloon animal if they are lucky! Gleneagles also has good accessibility.

After vaccination, parents should give some encouragement, and allow your child to share their feelings and emotions. You also need to get them prepared for the next dose in several weeks’ time.

What qualifies as “immunocompromised”?

Immunocompromised means if your child has cancer, or haematological malignancy, is a recipient of a solid organ transplant or stem cell transplant, has severe primary immunodeficiency or is on dialysis, has advanced or untreated HIV, is on active immunosuppressive drugs, or has undergone chemotherapy or radiotherapy in the past six months.

Even if your child has been infected with COVID-19 previously, you should go ahead with the vaccine or second dose of the vaccine. The community vaccination centres can advise on the correct protocols on whether to receive a third booster dose.

Q&A

Questions from members attending the talk included the dosage of paracetamol to give. Dr Yam recommended checking the concentration of the medicine that you have and usually it should be 10mg/kg. If the child is refusing oral medications there are other methods to get their temperature down, including keep them cool, wear loose clothing, warm bath (not cold bath) and give them plenty of liquids to ensure they are hydrated.

A member asked if a medical exemption form needs to be filled in or approved by Hospital Authority doctors or can private doctors do it? Dr Yam confirmed that any registered doctor should be able to do it.

Thank you to everyone for attending this talk and we hope you found it useful!