BCHHS Public Health Provider Update: Pediatric COVID vaccination

November 4, 2021

State and Local COVID-19 Update

  •          As of 11/3/2021, there have been 28,386 confirmed cases of COVID-19 and 426 COVID-19-related deaths in Buncombe County residents since the start of the pandemic.
  •          The case rate in Buncombe County continues to decline, and has fallen to 97 cases per 100,000 population in the last 7 days. The 14-day percent positivity also has fallen to 4.4%. COVID-related hospitalizations and ICU utilization in our region have stabilized following a downward trend.
  •          Buncombe County is still considered to have a high level of community transmission, per the CDC.
  •          Per the NCDHHS dashboard, 63% of the total Buncombe County population is partially vaccinated and 61% is fully vaccinated. When considering only those 12 years of age and older, 72% of this population in Buncombe County is partially vaccinated and 69% is fully vaccinated.
  •          The NCDHHS weekly Respiratory Disease Surveillance Report contains a wide variety of data on COVID-19, including post-vaccination surveillance data, attack rates and mortality rates by vaccination status (starting on page 11).
    •    For the week ending October 23, 2021, unvaccinated individuals in NC remain more than 4 times more likely to get COVID-19 and were 20.14 times more likely to die of COVID-19 when compared to vaccinated individuals.


Updates on COVID-19 Vaccine for 5-11 Year-Olds

  •          CDC’s Interim Clinical Considerations for Use of COVID-19 Vaccine Currently Approved or Authorized in the US was updated yesterday to reflect the recent recommendations and clinical guidance for use of the pediatric formulation of the Pfizer-BioNTech COVID-19 Vaccine in 5-11 year-olds.
  •          In the clinical trial for this age group, the vaccine efficacy estimate for prevention of symptomatic laboratory-confirmed COVID-19 was 91%.
  •          COVID-19 vaccination is recommended for everyone aged 5 years and older, regardless of a history of underlying medical conditions, symptomatic or asymptomatic SARS-CoV-2 infection, or seropositivity.


Dosing and formulation

  •          Children should receive the age-appropriate vaccine formulation regardless of their size or weight.
    •    Children aged 5–11 years should receive the 10 µg Pfizer-BioNTech COVID-19 Vaccine (orange cap) formulation.
    •    Adolescents aged ≥12 years should receive the 30 µg Pfizer-BioNTech COVID-19 Vaccine (purple cap) formulation.
  •          Children should receive the vaccine dosage and formulation based on their age on the day of vaccination with each dose.
    •    If a child turns 12 years old between their 1st and 2nd dose, they should receive the age-appropriate 30 µg Pfizer-BioNTech COVID-19 Vaccine (purple cap) formulation for their 2nd dose to complete their series.
      •   However, the FDA authorization allows children who will turn from 11 years to 12 years of age between their 1st and 2nd dose in the primary regimen to receive, for either dose, either:
      •          (1) the Pfizer-BioNTech COVID-19 Vaccine formulation for children aged 5–11 years (each 0.2 ml dose containing 10 µg in an orange cap vial); or
      •          (2) the Pfizer-BioNTech COVID-19 Vaccine formulation authorized for use in individuals 12 years of age and older (each 0.3 mL dose containing 30 mcg in a purple cap vial).
      •          If such dosing occurred, the child is considered fully vaccinated. This is not considered an error and VAERS reporting is not indicated.
  •          While moderately and severely immunocompromised persons aged ≥12 years (Pfizer-BioNTech recipients) or ≥18 years (Moderna recipients) should receive an additional primary dose of the mRNA COVID-19 vaccine administered for the primary series, an additional primary dose in children aged 5–11 years with moderate and severe immune compromise is not recommended.
  •          Booster doses are not recommended for people <18 years of age.


Side effects and adverse events

  •          Available safety and immunogenicity data for Pfizer-BioNTech COVID-19 vaccines in children and adolescents are similar to those seen in young adults.
  •          The most common side effects were pain at the injection site, fatigue, headache and muscle aches, but local and systemic reactions following vaccination were less frequent in children aged 5–11 years compared with young adults aged 16–25 years.
  •          No cases of myocarditis were reported among the 3,082 participants aged 5–11 years in Pfizer-BioNTech’s vaccine trial with at least 7 days of follow up after receipt of dose 2, although the study was not powered to assess the risk for myocarditis. The observed risk of myocarditis after mRNA COVID-19 vaccination in adolescents may not be generalizable to younger children since the baseline risk of myocarditis prior to the pandemic was higher in children aged 12-17 years compared to children aged 5-11 years. Therefore, based on the lower baseline risk of myocarditis in 5-11 year-olds and the fact that the vaccine dose used in this age group is 1/3 the dose used in older children, while the rate of myocarditis after vaccination in 5-11 year-olds is unknown at this time, it is expected to be lower than the rate in the 12-17 year-old population.


CDC Clinician Call on COVID Vaccination of 5-11 Year Olds


Additional updates to CDC’s Interim Clinical Considerations for Use of COVID-19 Vaccine Currently Approved or Authorized in the US

  •          People who received passive antibody products
    •    Passive antibody product used for post-exposure prophylaxis: defer COVID-19 vaccination for 30 days
    •    Passive antibody product used for COVID-19 treatment: defer COVID-19 vaccination for 90 days
    •    However, if passive antibody products and a COVID-19 vaccine dose are administered within these recommended deferral periods (30 or 90 days), the vaccine dose does not need to be repeated.
  •          Clarification of severe versus non-severe reactions and observation periods (also appendix B)
  •          Updated ingredient list


Updates on Buncombe County COVID-19 Vaccination Efforts

  •          Walk-in COVID-19 Vaccine Clinic
    •    BCHHS building, 40 Coxe Avenue in downtown Asheville
    •    All FDA-authorized or FDA-approved COVID-19 vaccines and all doses are available here.
      •   We will begin providing Pfizer vaccine to 5-11 year-olds tomorrow, Friday, 11/5.
    •    The clinic is open Monday-Friday from 9am-4pm.
    •    No appointment needed.
  •          School-based Saturday COVID-19 Vaccine Clinics
    •    Several school-based Saturday clinics across the county are scheduled for November & December. Please see more information about these and other pediatric vaccine clinics here.
  •          COVID-19 vaccines for the homebound
    •    We are able to provide any recommended dose of COVID-19 vaccine to those living in Buncombe County who cannot easily leave their homes to access vaccination.
    •    If you know someone in need of this service, have them or their caregiver call the Buncombe County Ready Team at 828-419-0095.

If you have any concerns or questions about COVID-19 or any other communicable disease, please contact the Buncombe County Communicable Disease staff at 828-250-5109 (available 24/7).