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Vaccination of children against COVID-19: the experience in Latin America

The Coronavirus Disease 2019 (COVID-19) caused by the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has spread globally, becoming a long-lasting pandemic [1,2,3]. As is so often the case for infectious diseases, vulnerable communities are likely to demonstrate the worse effects and this holds true for COVID-19 in Latin America [4].

Early in the pandemic, it was believed that COVID-19 did not significantly affect children. However, since the first confirmed pediatric case of COVID-19 was reported in Shenzhen, China, many cases have been reported and studied in pediatric patients [5]. It is now known that COVID-19 can affect children of all ages [6,7,8,9]. Although in many settings children usually have a lower risk of exposure and are tested less frequently than adults, the incidence in some countries in children is similar to that in adults [10].

During the surveillance in several countries, children typically account for up to 16% of laboratory-confirmed cases or even more, depending on the vaccinated groups. For example, in the United States, total childhood cases of COVID-19 reported since the beginning of the pandemic were 12.7 million cases, accounting for 19.0% of all cases [11].

In early reports of the disease in children, most cases resulted from exposure to SARS-CoV-2 within the home from contact with an adult carrier [7, 12, 13]. However, social gatherings with people outside the home and meeting other children at play activities were also associated with the transmission of the virus [14]. In addition, transmission related to health care and school attendance has also been reported [15,16,17,18].

COVID-19 infection mainly targets older people with comorbidities; children infected with SARS-CoV-2 have similar symptoms as adults; however, they have a milder course of illness and a better prognosis than adults, requiring less hospital admission [19, 20]. The primary infection characteristics in pediatric patients are fever and cough; diarrhoea, vomiting, nasal congestion, and fatigue may be found in a lesser proportion [21]. Forty-two per cent of the cases could generate an asymptomatic clinical picture, and 3% require hospitalisation [22]. Multisystem Inflammatory Syndrome in Children (MIS-C) is a severe complication of exposure to SARS-CoV-2 viruses, which may require admission to intensive care, mechanical ventilation, and cardiorespiratory support. However, it rarely leads to death [23, 24]. This clinical syndrome is characterised by fever, systemic inflammation, and multisystem involvement, most commonly abdominal and cardiac, apparently driven by an uncontrolled immune response [24, 25].

Immunisation is the most effective public health strategy against the SARS-CoV-2 pandemic [26]. Vaccines protect children and reduce the spread of disease to families and communities; given the lower risk of severe COVID-19 in young children, vaccine safety is paramount, monitored by the Centers for Disease Control and Prevention and other national or regional agencies [27].

Early in the pandemic, there was a compelling need to quickly develop vaccines in less than a year to prevent the viral spread and save lives [28]. The COVID-19 vaccine is necessary to achieve herd immunity and is essential to mitigate the spread of the pandemic [29].

Currently, there are 9 vaccines with greater than 50% efficacy against symptomatic COVID-19 in adults: with 96% we have NVX-CoV2373 (Novavax, USA), with 95% BNT162b2 (Pfizer/BioNTech, USA & Germany), with 94.1% mRNA-1273 (Moderna, USA), with 92% Sputnik V (Gamaleya, Russia), 63.09% AZD1222 (Oxford/AstraZeneca), 79% BBIBP-CorV (Sinopharm, China), 77.8% Covaxin (Barat Biotech, India), 66.9% Ad26. CoV.S “Janssen” (Johnson & Johnson, USA) and with 50.4% CoronaVac (Sinovac, China) [30, 31].

More than 1698 million doses have been administered in the Americas, completing with a complete immunisation schedule for more than 672 million people. The countries with the highest percentage of complete schemes per-100 inhabitants are the Cayman Islands (94.65%), Puerto Rico (92.09%), Chile (89.93%), Cuba (87.34%) Saba Island (81.27%). The most widely used vaccines in the continent were from Pfizer/BioNTech, Moderna, and Sinovac laboratories [32].

The impact of COVID-19 on the education, health, and well-being of the pediatric population has been significant. Because of this, immunisation coverage against COVID-19 in this population is necessary [33]. Although vaccination in children and adolescents is essential to reduce infection and transmission of the virus from the vaccinated to the susceptible person, in many countries, it is necessary to restore the stability of the educational system, mental and emotional health, and for their parents, due to the severe labour, economic and social problems caused by the closure of schools [33].

Despite the significant advances achieved with the various types of vaccines, only a few vaccines against COVID-19 have completed clinical trials in children (Table 1) and there are a further 28 underway [34]. Thus, the Pfizer/BioNTech vaccine is the first COVID-19 vaccine to be licensed for emergency use in children aged 5 to 17 years in the United States [35].

Table 1 Summary of clinical trials of COVID-19 vaccines in children

Some vaccines not yet approved by regulatory agencies such as the U.S. Federal Drugs Administration (FDA) or the WHO are being applied in some Latin American countries; for example, Chile approved the Sinovac COVID-19 vaccine for children over 6 years. El Salvador licensed COVID-19 vaccination for children aged 6 to 11 years. Argentina is vaccinating children as young as three years old with the Sinopharm COVID-19 vaccine. Ecuador's vaccination includes children as young as six years old with the Sinovac vaccine. Colombia offers COVID-19 vaccines from AstraZeneca, Moderna, Sinopharm, and Johnson & Johnson for children 12 years and older. Finally, Costa Rica is vaccinating from 12 years of age [42].

The distribution of vaccines against COVID-19 in Latin America is unevenly distributed. For example, Argentina has more than 16.6 million doses administered, Chile more than 7.2 million, and Ecuador more than 6.7 million. Most countries have started vaccination at 5 years of age. The most widely used vaccine in the region is the Pfizer/BioNTech vaccine (Fig. 1).

Fig. 1
figure 1

COVID-19 vaccines doses administered in children and adolescents in Latin America. Only countries with public data on vaccination in children and adolescents are included. Updated March 8, 2021

COVID-19 vaccines have proven effective and safe, demonstrating their effectiveness in reducing symptomatic disease, hospitalisations, and deaths; however, there are significant challenges, including approval by regulatory systems, and vaccine availability in all countries. In addition, there is still a lack of data on the efficacy of COVID-19 vaccines administered as a third (booster) dose, with some studies reporting that the booster dose increases the antibody and neutralising response, providing additional protection against SARS-CoV-2 infection for vaccines [43, 44].

It is very likely that, as the vaccination program progresses in the countries of Latin America, the target population will be modified to include the pediatric population which has been ignored in most countries, causing an increase in the incidence of infection in this population. It can be hoped that increased vaccination in the paediatric population will reverse this trend.

References

  1. Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395:497. https://doi.org/10.1016/S0140-6736(20)30183-5.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  2. Singh S, McNab C, Olson RM, Bristol N, Nolan C, Bergstrøm E, et al. How an outbreak became a pandemic: a chronological analysis of crucial junctures and international obligations in the early months of the COVID-19 pandemic. Lancet. 2021. https://doi.org/10.1016/S0140-6736(21)01897-3.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Valencia DN. Brief review on COVID-19: the 2020 pandemic caused by SARS-CoV-2. Cureus. 2020. https://doi.org/10.7759/CUREUS.7386.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Wang MY, Zhao R, Gao LJ, Gao XF, Wang DP, Cao JM. SARS-CoV-2: structure, biology, and structure-based therapeutics development. Front Cell Infect Microbiol. 2020. https://doi.org/10.3389/FCIMB.2020.587269.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Chen ZM, Fu JF, Shu Q, Chen YH, Hua CZ, Li FB, et al. Diagnosis and treatment recommendations for pediatric respiratory infection caused by the 2019 novel coronavirus. World J Pediatr. 2020;16:240–6. https://doi.org/10.1007/S12519-020-00345-5.

    CAS  Article  PubMed  Google Scholar 

  6. Wei M, Yuan J, Liu Y, Fu T, Yu X, Zhang ZJ. Novel coronavirus infection in hospitalised infants under 1 year of age in China. JAMA. 2020;323:1313–4. https://doi.org/10.1001/JAMA.2020.2131.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  7. Bialek S, Gierke R, Hughes M, McNamara LA, Pilishvili T, Skoff T. Coronavirus disease 2019 in children—United States, February12–April 2 2020. MMWR. 2020;69:422–6. https://doi.org/10.15585/MMWR.MM6914E4.

    Article  PubMed Central  Google Scholar 

  8. Zimmermann P, Curtis N. Coronavirus infections in children including COVID-19: an overview of the epidemiology, clinical features, diagnosis, treatment and prevention options in children. Pediatr Infect Dis J. 2020;39:355–68. https://doi.org/10.1097/INF.0000000000002660.

    Article  PubMed  PubMed Central  Google Scholar 

  9. de Lusignan S, Dorward J, Correa A, Jones N, Akinyemi O, Amirthalingam G, et al. Risk factors for SARS-CoV-2 among patients in the Oxford Royal College of general practitioners research and surveillance centre primary care network: a cross-sectional study. Lancet Infect Dis. 2020;20:1034–42. https://doi.org/10.1016/S1473-3099(20)30371-6.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Dawood FS, Porucznik CA, Veguilla V, Stanford JB, Duque J, Rolfes MA, et al. Incidence rates, household infection risk, and clinical characteristics of SARS-CoV-2 infection among children and adults in Utah and New York City, New York. JAMA Pediatr. 2021. https://doi.org/10.1001/JAMAPEDIATRICS.2021.4217.

    Article  Google Scholar 

  11. American Academy of Pediatrics. Children and COVID-19: state-level data report 2021. https://www.aap.org/en/pages/2019-novel-coronavirus-covid-19-infections/children-and-covid-19-state-level-data-report/. Accessed 8 Mar 2022.

  12. Liguoro I, Pilotto C, Bonanni M, Ferrari ME, Pusiol A, Nocerino A, et al. SARS-COV-2 infection in children and newborns: a systematic review. Eur J Pediatr. 2020;179:1029–46. https://doi.org/10.1007/S00431-020-03684-7.

    CAS  Article  PubMed  Google Scholar 

  13. Posfay-Barbe KM, Wagner N, Gauthey M, Moussaoui D, Loevy N, Diana A, et al. COVID-19 in children and the dynamics of infection in families. Pediatrics. 2020. https://doi.org/10.1542/PEDS.2020-1576.

    Article  PubMed  Google Scholar 

  14. Hobbs CV, Martin LM, Kim SS, Kirmse BM, Haynie L, McGraw S, et al. Factors associated with positive SARS-CoV-2 test results in outpatient health facilities and emergency departments among children and adolescents aged. MMWR. 2020;69:1925–9. https://doi.org/10.15585/MMWR.MM6950E3.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  15. Schwierzeck V, König JC, Kühn J, Mellmann A, Correa-Martínez CL, Omran H, et al. First reported nosocomial outbreak of severe acute respiratory syndrome coronavirus 2 in a pediatric dialysis unit. Clin Infect Dis. 2021;72:265–70. https://doi.org/10.1093/CID/CIAA491.

    CAS  Article  PubMed  Google Scholar 

  16. Krass P, Zimbrick-Rogers C, Iheagwara C, Ford CA, Calderoni M. COVID-19 outbreak among adolescents at an inpatient behavioral health hospital. J Adolesc Health. 2020;67:612–4. https://doi.org/10.1016/J.JADOHEALTH.2020.07.009.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Brown NE, Bryant-Genevier J, Bandy U, Browning CA, Berns AL, Dott M, et al. Antibody responses after classroom exposure to teacher with coronavirus disease, March 2020. Emerg Infect Dis. 2020;26:2263–5. https://doi.org/10.3201/EID2609.201802.

    CAS  Article  PubMed Central  Google Scholar 

  18. Macartney K, Quinn HE, Pillsbury AJ, Koirala A, Deng L, Winkler N, et al. Transmission of SARS-CoV-2 in Australian educational settings: a prospective cohort study. Lancet Child Adolesc Health. 2020;4:807–16. https://doi.org/10.1016/S2352-4642(20)30251-0.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  19. Ludvigsson JF. Systematic review of COVID-19 in children shows milder cases and a better prognosis than adults. Acta Paediatr. 2020;109:1088–95. https://doi.org/10.1111/APA.15270.

    CAS  Article  PubMed  Google Scholar 

  20. Lee PI, Hu YL, Chen PY, Huang YC, Hsueh PR. Are children less susceptible to COVID-19? J Microbiol Immunol Infect. 2020;53:371. https://doi.org/10.1016/J.JMII.2020.02.011.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  21. Bhopal SS, Bagaria J, Olabi B, Bhopal R. Children and young people remain at low risk of COVID-19 mortality. Lancet Child Adolesc Health. 2021;5:e12–3. https://doi.org/10.1016/S2352-4642(21)00066-3.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  22. Parri N, Magistà AM, Marchetti F, Cantoni B, Arrighini A, Romanengo M, et al. Characteristic of COVID-19 infection in pediatric patients: early findings from two Italian pediatric research networks. Eur J Pediatr. 2020;179:1315. https://doi.org/10.1007/S00431-020-03683-8.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  23. Yock-Corrales A, Lenzi J, Ulloa-Gutiérrez R, Gómez-Vargas J, Antúnez-Montes OY, Rios Aida JA, et al. High rates of antibiotic prescriptions in children with COVID-19 or multisystem inflammatory syndrome: a multinational experience in 990 cases from Latin America. Acta Paediatr. 2021;110:1902. https://doi.org/10.1111/APA.15847.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  24. Buonsenso D, Riitano F, Valentini P. Pediatric inflammatory multisystem syndrome temporally related with SARS-CoV-2: immunological similarities with acute rheumatic fever and toxic shock syndrome. Front Pediatr. 2020;8:574. https://doi.org/10.3389/FPED.2020.00574.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Whittaker E, Bamford A, Kenny J, Kaforou M, Jones CE, Shah P, et al. Clinical characteristics of 58 children with a pediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2. JAMA. 2020;324:259–69. https://doi.org/10.1001/JAMA.2020.10369.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  26. Urrunaga-Pastor D, Herrera-Añazco P, Uyen-Cateriano A, Toro-Huamanchumo CJ, Rodriguez-Morales AJ, Hernandez AV, et al. Prevalence and factors associated with parents’ non-intention to vaccinate their children and adolescents against COVID-19 in Latin America and the Caribbean. Vaccines. 2021;9:1303. https://doi.org/10.3390/VACCINES9111303.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  27. Moss WJ, Gostin LO, Nuzzo JB. Pediatric COVID-19 vaccines: what parents, practitioners, and policy makers need to know. JAMA. 2021. https://doi.org/10.1001/JAMA.2021.20734.

    Article  PubMed  Google Scholar 

  28. Goldschmidt K. COVID-19 vaccines for children: the essential role of the pediatric nurse. J Pediatr Nurs. 2021;57:96. https://doi.org/10.1016/J.PEDN.2020.12.004.

    Article  PubMed  Google Scholar 

  29. Choi SH, Jo YH, Jo KJ, Park SE. Pediatric and parents’ attitudes towards COVID-19 vaccines and intention to vaccinate for children. J Korean Med Sci. 2021;36:1–12. https://doi.org/10.3346/JKMS.2021.36.E227.

    CAS  Article  Google Scholar 

  30. Hadj HI. COVID-19 vaccines and variants of concern: a review. Rev Med Virol. 2021. https://doi.org/10.1002/RMV.2313.

    Article  Google Scholar 

  31. Talukder A, Kalita C, Neog N, Goswami C, Sarma MK, Hazarika I. A comparative analysis on the safety and efficacy of Covaxin versus other vaccines against COVID-19: a review. Zeitschrift Für Naturforschung C. 2022. https://doi.org/10.1515/ZNC-2021-0301.

    Article  Google Scholar 

  32. Pan American Health Organization (PAHO). Vacunacion contra COVID-19 en las Americas 2021. https://ais.paho.org/imm/IM_DosisAdmin-Vacunacion-es.asp. Accessed 8 Mar 2022.

  33. Moraga-Llop F. Vacunación frente a la COVID-19 en los adolescentes. Una realidad Vacunas. 2021;22:135–7. https://doi.org/10.1016/J.VACUN.2021.05.003.

    CAS  Article  Google Scholar 

  34. Lv M, Luo X, Shen Q, Lei R, Liu X, Liu E, et al. Safety, immunogenicity, and efficacy of COVID-19 vaccines in children and adolescents: a systematic review. Vaccines. 2021;9:1102. https://doi.org/10.3390/VACCINES9101102/S1.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  35. FDA. FDA Authorizes Pfizer-BioNTech COVID-19 vaccine for emergency use in children 5 through 11 years of age n.d. https://www.fda.gov/news-events/press-announcements/fda-authorizes-pfizer-biontech-covid-19-vaccine-emergency-use-children-5-through-11-years-age. Accessed 8 Mar 2022.

  36. Frenck RW, Klein NP, Kitchin N, Gurtman A, Absalon J, Lockhart S, et al. Safety, immunogenicity, and efficacy of the BNT162b2 COVID-19 vaccine in adolescents. N Engl J Med. 2021;385:239–50. https://doi.org/10.1056/NEJMOA2107456.

    CAS  Article  PubMed  Google Scholar 

  37. Walter EB, Talaat KR, Sabharwal C, Gurtman A, Lockhart S, Paulsen GC, et al. Evaluation of the BNT162b2 COVID-19 vaccine in children 5 to 11 years of age. N Engl J Med. 2022;386:35–46. https://doi.org/10.1056/NEJMoa2116298.

    CAS  Article  PubMed  Google Scholar 

  38. Xia SL, Zhang YT, Wang YX, Wang H, Yang YK, Gao GF, et al. Safety and immunogenicity of an inactivated COVID-19 vaccine, BBIBP-CorV, in people younger than 18 years: a randomised, double-blind, controlled, phase 1/2 trial. Lancet Infect Dis. 2022;22:196–208. https://doi.org/10.1016/S1473-3099(21)00462-X.

    CAS  Article  PubMed  Google Scholar 

  39. Zhu F, Jin P, Zhu T, Wang W, Ye H, Pan H, et al. Safety and immunogenicity of a recombinant adenovirus type-5–vectored coronavirus disease 2019 (COVID-19) vaccine with a homologous prime-boost regimen in healthy participants aged ≥6 years: a randomised, double-blind, placebo-controlled, phase 2b trial. Clin Infect Dis. 2021. https://doi.org/10.1093/CID/CIAB845.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Han B, Song Y, Li C, Yang W, Ma Q, Jiang Z, et al. Safety, tolerability, and immunogenicity of an inactivated SARS-CoV-2 vaccine (CoronaVac) in healthy children and adolescents: a double-blind, randomised, controlled, phase 1/2 clinical trial. Lancet Infect Dis. 2021. https://doi.org/10.1016/S1473-3099(21)00319-4.

    Article  PubMed  PubMed Central  Google Scholar 

  41. Ali K, Berman G, Zhou H, Deng W, Faughnan V, Coronado-Voges M, et al. Evaluation of mRNA-1273 SARS-CoV-2 vaccine in adolescents. N Engl J Med. 2021. https://doi.org/10.1056/NEJMoa2109522.

    Article  PubMed  PubMed Central  Google Scholar 

  42. REUTERS. Factbox: countries vaccinating children against COVID-19 | Reuters 2021. https://www.reuters.com/business/healthcare-pharmaceuticals/countries-vaccinating-children-against-covid-19-2021-06-29/. Accessed 8 Mar 2022.

  43. Saciuk Y, Kertes J, Shamir Stein N, Ekka ZA. Effectiveness of a third dose of BNT162b2 mRNA vaccine. J Infect Dis. 2022;225:30–3. https://doi.org/10.1093/INFDIS/JIAB556.

    CAS  Article  PubMed  Google Scholar 

  44. Munro APS, Janani L, Cornelius V, Aley PK, Babbage G, Baxter D, et al. Safety and immunogenicity of seven COVID-19 vaccines as a third dose (booster) following two doses of ChAdOx1 nCov-19 or BNT162b2 in the UK (COV-BOOST): a blinded, multicentre, randomised, controlled, phase 2 trial. Lancet. 2021;398:2258–76. https://doi.org/10.1016/S0140-6736(21)02717-3.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgement

We dedicate this article to the memory of Dr. Barbara Bisiacchi, MD, PhD, who died in February 2022. She was an Italian-Venezuelan medical educator, professor of physiology at the Vargas Medical School, Universidad Central de Venezuela.

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AJR-M, DAL-F, and LR conceived the idea for the manuscript and conducted the search for information. AJR-M, DAL-F, and LR drafted the initial version of the manuscript. DAL-F and LR designed the tables and graphs used in the manuscript. AJR-M, TDM, and HL critically reviewed the manuscript. All authors read and approved the final manuscript.

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Correspondence to Alfonso J. Rodriguez-Morales.

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Tim McHugh and Hakan Leblebicioglu are the Editors-in-Chief of Annals of Clinical Microbiology and Antimicrobials. Alfonso J. Rodriguez-Morales is the Deputy Editor-in-Chief of Annals of Clinical Microbiology and Antimicrobials.

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Rodriguez-Morales, A.J., León-Figueroa, D.A., Romaní, L. et al. Vaccination of children against COVID-19: the experience in Latin America. Ann Clin Microbiol Antimicrob 21, 14 (2022). https://doi.org/10.1186/s12941-022-00505-7

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