Pediatric COVID-19 case counts likely 'tip of the iceberg,' expert says
NEW YORK — A CDC official said that pediatric COVID-19 cases likely have been underreported and reassured providers about the safety of vaccination during a keynote at this year’s Infectious Diseases in Children Symposium.
Sara Oliver MD, MSPH, an Epidemic Intelligence Service officer in the Division of Viral Diseases at the CDC, leads the Advisory Committee on Immunization Practices work group on COVID-19 and gave the presentation on the first day of the conference. She cited CDC data that indicated COVID-19 cases have been increasing.
“At the end of October, we were around 60,000 cases per day, and we're now back up to around 80,000 cases per day,” Oliver said. “We've got to kind of watch and see what happens as various other parts of the country are experiencing that delta surge. But we do know that children represent a large proportion of that.”
Oliver said that more than 2 million cases have occurred in children aged 5 to 11 years, and more than 2. 5 million cases have occurred in teens. About 20% of new cases were found in children, she added.
“Early in the pandemic, this was [thought to be] a pandemic that was in the elderly or the older population,” Oliver said. “As that population was vaccinated early, we've really seen the shift in this pandemic to be among younger populations.”
Additionally, COVID-19 was not the only disease affecting children during the pandemic, she added.
“We've actually seen double the cases of hospitalization for type 2 diabetes over the pandemic than we normally see,” Oliver said. “So it is not just COVID-19 that is impacting these kids. They're being hospitalized for a variety of other things that are directly caused from the pandemic. [There is the] decrease in health care utilization and routine immunizations, increase in adverse childhood experiences, and loss of caregivers, with thousands of kids now who have lost one or both parents.”
“So as we think through what the epidemic is in children and adolescents, we know that they're at least as likely to be infected as adults — again, over 4.9 million cases in this 5- to 17-year-old age group, with their prevalence somewhere between 38% and 39%,” Oliver continued. “But we know that that may just be a tip of the iceberg.”
She added that cases are likely underreported.
“For every case that we hear about, how many infections are there, potentially?” Oliver said. “Across the general population, we think that's about two to one, so for every case we hear about, there's potentially two cases we don’t. For pediatrics, that's six to one. So, for every diagnosed case that we see out there, there are potentially six cases out there that are potentially not diagnosed and reported.”
Myocarditis risk associated with mRNA vaccines
Although reports of myocarditis cases following vaccination with messenger RNA technology is an area of concern, these cases are rare — occurring mostly in young men. Oliver said it was something the ACIP “needed to think through” before recommending to authorize the Pfizer-BioNTech pediatric vaccine for emergency use.
“It's a rare event, primarily in males less than 30, particularly after the second dose,” Oliver said. “ACIP has thought through this as it's related to adolescents and young adults, and has continued to feel that the benefits outweigh the risks and still to recommend the vaccine.”
Oliver ended her remarks by saying that providers and pediatricians played more of a role than they might realize in increasing vaccination rates.
“We know that if a pediatrician recommended a COVID-19 vaccine, the parents [and children] were more likely to get it,” Oliver said. “So I think the biggest thing that [providers] can do is just continue to talk about it. And it may not be at the first visit, it may not be at the second visit, but a trusted person in that parent's life really having a conversation with them about the vaccine is what will impact [people], more than anything I can do at the CDC.”