Glossary

• Virus– a type of germ that consists solely of a bit of genetic material (DNA or RNA) wrapped in a protein coat.  The coat gets the genes into the target cell where the genes force the cell to make zillions of new viruses (genes and protein coat), and on it goes.
• Variant- also known as a mutation, a variant strain of a virus is the same species of virus but with a change in the genetic code.  The change is minor if it has no impact on contagious the new variant is, or how deadly it is, or if it allows the virus to neutralize our vaccines. Variants that substantially increase harm are now listed by Greek letters, the most troublesome one now is Omicron.

• Coronavirus– a species name of a number of different viruses.  Called corona because its protein coat is studded with spike shapes that form a crown, halo, or corona of spikes
• SARS-CoV-2– the specific name of the new coronavirus
• COVID-19-the name of the illness that the new coronavirus is causing
• Endemic– an illness always present in a region.  One could say strep throat is endemic in the US
• Epidemic– a sudden burst of an illness that comes and goes over a limited time
• Pandemic– an epidemic that bursts across the world not just one region
• Spreadability– how contagious is the disease, how many people will end up infected
• Symptoms- the experience of being ill, for example- fever, cough, headaches, loss of smell etc.
• Asymptomatic– literally means “without symptoms”.  For COVID-19 it refers a person infected with the virus but has no and will have not symptoms
• Presymptomatic– This is a person who was infected with SARS-CoV-2, and will feel sick, but hasn’t yet
• Severity– what harm does the disease cause, in terms of  how sick you get and how many it will kill
• Mask- a mask is a loose-fitting cloth or textile that covers the mouth and nose loosely.  A surgical mask is a mask used in surgery
• Respirator-  for the purposes of the COVID-19 pandemic and other respiratory illnesses, a respirator is a mask that fits very snugly or tightly to the user’s face.  An N95 mask is a respirator.
• PCR Test–  swabs the nose to detect the genes of the COVID virus.  The genes if detected are almost certainly there, but they can persist long after contagion ends.  Very few false positives, positives can be trusted.
• Antigen Test (the home kit)- swabs the nose to detect the proteins on the coating of the COVID virus, the spike proteins.  If it does not detect those proteins, you are almost certainly not infected, negatives can be trusted.  These proteins are also on the coating of many common cold viruses, so one positive test may indicate you have a cold rather than COVID.  Two positive home tests though reliably indicate you have COVID.
• Vaccine Terms
• Vaccine or Immunization– a dose of a substance that activates your immune system, as if you have the actual infection you are hoping to prevent, leaving you in fact protected from having that infection.
• Efficacy– the percentage of people immunized with a particular vaccine who will not get infected if exposed to the target infection.  For example, a COVID-19 vaccine will be said to be 95% effective if 95% of people immunized with that particular COVID-19 vaccine will not get COVID-19 if exposed to COVID-19
• mRNA– DNA works by dictating exactly which proteins your cell will make.  The message on how to construct each protein is delivered to the cell machinery that makes proteins by a piece of genetic material called messenger RNA, or mRNA
• mRNA vaccine– an mRNA vaccine places a small bit of mRNA code that makes your cells make a protein that is the protein from a virus that alerts your immune system and activates it to make protections against you being infected
• Viral vector vaccine– a viral vector vaccine takes a harmless virus that is known to infect people reliably and places that weakened virus in a person where that virus will in fact infect the person.  The virus is not only weakened, but also attached to a set of genes  that makes your cells make a protein that is the protein from a virus that alerts your immune system and activates it to make protections against you being infected.

COVID Vaccination Opening for All 6 Month to 4 Year Olds

The confidence that the FDA will approve use of COVID vaccine for all children ages 6 months through 4 years old next week is high enough, that this vaccine is being shipped around the nation, and our office is planning to offer it soon.

As a reminder, there are 3 steps that need to occur before we can give anyone the 6m-4y old COVID vaccine:

1. FDA authorization- meeting June 15 to decide
2. CDC recommendation- they meet usually within days of FDA authorization
3. Having the vaccine vials in the office and ready to give

Our office, Akron Children’s Hospital Pediatrics- Beachwood, is very pleased to announce that you will be able to start scheduling, not receiving, COVID vaccination for your 6m-4y old child, on MyChart, starting June 14.

Keep these points in mind about setting up your 6m-4y old for COVID vaccination:

1. The gate opens to book a time, only via My Chart, and on June 14.
2. We will not have COVID vaccine to give to this age group on June 14, no one in the US will.
3. Once again, the ability to book an appointment on June 14, as of today, can only be via MyChart.
4. To schedule via MyChart your child has to be enrolled in our Akron Children’s Hospital Pediatrics My Chart system.  For COVID vaccine booking, anyone can book their child, whether in the practice or not, once you go online and sign up for Akron Children’s MyChart.

As the FDA and CDC actions occur and we receive the new vials for the 6m-4y COVID vaccine, we will be opening up our front office to make these appointments and for the same day if you choose, too.

There are no plans to develop a COVID vaccine for babies from birth through 5 months of age, so this will be the last age group to be added.

Updates on the Specifics of the COVID Vaccine for the 6 month old through 4 year old child.

It is fully expected that the US will endorse the use of the Pfizer and Moderna COVID vaccines for this age group.

Our office will start offering COVID vaccine to this age group with only the Pfizer vaccine.

For both Pfizer and Moderna COVID vaccines for this age group, the amount of immunization material in the vaccine is dramatically smaller than the amount in the adult or even the 5-11 year old vaccine.

The units are different for the Pfizer and Moderna vaccine, so it can be misleading to compare total amounts of immunization material between these versions.

Here is how it shakes out:

For the Moderna vaccine, their vaccine has 100 micrograms of immunization material (mcg) in each adult vaccine, and 50 mcg in each adult booster vaccine.  As of now, Moderna has no COVID vaccine for the 5-17 year olds.  Their 6m-4y old vaccine coming out now will have 25 mcg.

For the Pfizer vaccine, their vaccine has 30 micrograms of immunization material (mcg) in each year and older vaccine and booster, and 10 mcg in each 5-11 year old vaccine. Their 6m-4y old vaccine coming out now will have 3 mcg.

Again, given that the units are not comparable, the fact that Pfizer will have 3 mcg and Moderna will have 25 mcg does not mean that one has that much more than the other vaccine power.

Dosing Intervals

For the Pfizer vaccine for the 6 month old through 4 year old children, the doses now go to a total of 3 vaccines for the primary series and the intervals go like this:

Vaccine #1

At least 3 weeks pass, then

Vaccine #2

At least 2 months pass, then

Vaccine #3

The Moderna vaccine is 2 doses for the 6m-4 y olds, at least one month apart.

Efficacy

Stay tuned for more data as the FDA and CDC complete their reviews, but the data we have in hand shows that both the Pfizer and Moderna vaccines for COVID for 6 month through 4 years of age met their target of working well, and both were very, very safe.

In terms of preventing actual infection as proven by lab testing, the Pfizer was 80% effective after all 3 doses, and the Moderna 30-50% after both doses.

Why Do This?

The question comes up often- COVID is milder the younger you are, so why bother immunizing my baby if the chances of severe illness are so low?

There are good, solid reasons to make sure you protect your baby:

First, Babies and toddlers are unlikely to get severely ill, but still do.  An immunized young child is far less likely to come to harm from getting COVID than the unimmunized child.

Second, We simply do not know the long-term impact of COVID infection, at any age.  It seems very, very likely that a young person having a mild course will have no long-term impact.  But COVID is a strange new virus, and we know that immunized people have far, far milder impact from this virus.

Third, We know from influenza virus that many elderly members of families get their respiratory viruses from their grandchildren.  When all children get immunized,  more grandparents survive viral epidemics.

Bottom Lines:

1. Starting on June 14, our office, Akron Children’s Hospital Pediatrics-Beachwood, will open MyChart, and only MyChart, accounts to book 6 month through 4 year olds, for their COVID vaccine!
2. We will not have COVID vaccine to give on June 14, the only change that day is that the schedule, only by MyChart, opens that day, to book later.
3. We cannot give the actual vaccine to 6m-4y olds until the FDA authorizes (expected June 15), CDC recommends (some days after June 15), and we have the new vials in hand (likely before July 1).
4. Our office will offer the Pfizer only, which is a 3 dose series.
5. The dosing interval is:  Dose 1, followed by at least 3 weeks then, Dose 2, followed by at least 2 months then, Dose 3.
6. Both Moderna and Pfizer are clearly very, very safe, and work very, very well.  The difference in efficacy is not large so either are a good option.
7. Although, thankfully, babies, toddlers, and pre-schoolers have milder COVID than older kids and adults, the choice between vaccinating and not vaccinating is clear.  For many reasons, your child is worse off not vaccinated and so much better off with the vaccine.

My One Takeaway Sentence:
Stay tuned to final recommendations from the CDC to follow the FDA authorization, we will likely have some more detail to report on the above, but the ability to protect EVERYONE from ages 6 MONTHS and UP will be here soon!

To your health,
Dr. Arthur Lavin