Four Seasons Pediatrics

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COVID Vaccine and Sick Visit Update

The Bivalent COVID Vaccine has now been approved for down to 6 months of age and is now available for some children in this age range.  Remember that the vaccine received an update to include the Omicron Mutation.  COVID-19 booster vaccines targeting the Omicron BA.4 and BA.5 subvariants have been approved by the FDA and CDC.   This had been previously approved for ages 5-11 and 12 and up as a Booster dose. 

• We recommend it for everyone aged 5 years and older if it has been at least 2 months since your last dose and you have not had the Bivalent Vaccine (the updated vaccine).  

• We recommend it for 6 months – 4 years as a booster IF you completed the Moderna primary series, AND it has been at least 2 months since your last dose.  For this age range  you should get the Moderna vaccine (we do not carry the Moderna Vaccines)

• We recommend it for 6 months – 4 years as the 3rd dose of the Pfizer primary series if you have not had your 3rd dose yet.  We currently have it available and it replaces the 3rd dose of the original vaccine.  It is not recommended as a booster dose if you had all 3 of the Pfizer doses in this age range AT THE PRESENT TIME.  

Should I get this vaccine booster if I received the other doses?

We feel that you should.  Up until now, the current COVID vaccine has had the original virus surface proteins since it was first developed.  We knew that the virus would mutate and it will continue to do so.  Remember that COVID began around December of 2019.  It was not until December of 2020 that the original vaccine came out.  This vaccine showed excellent protection for almost a full year until the Delta mutation came along.  Delta eroded some of the protection for infection, but it still worked well to prevent serious infection and MIS-C (reducing it by 90% in children).  After the Omicron variant came along last January 2022, the original vaccine protection was limited to about 10-12 weeks.  We feel that the new booster will restore more prolonged protection from infections UNTIL significant mutations occur again.  If there was almost 2 years before the original vaccine was affected by mutations, we have good reason to believe that the updated bivalent vaccine will provide protection that is long lasting.  

Was this studied enough?

You may be hearing news stories about this being tested only in mice.  Let’s clarify some of that information.  This transition to updating vaccines for COVID-19 is being done much like the US updates its flu vaccine annually, tweaking the formula of an established vaccine platform.  Earlier in 2022, vaccine makers submitted data to the FDA on an updated vaccine that targeted BA.1 (the first Omicron Mutation and the previously predominant Omicron variant). But then the FDA asked the companies to update their vaccines to add an Omicron BA.4/5 component, to create a vaccine that is a bivalent booster — meaning it will cover both the original strain of the virus that emerged from China and the newer BA.4 and BA.5 subvariants.  The BA.1 vaccine did show protection but not as much antibody protection for BA.4/5.  With BA.4/5 added, antibody levels are higher for the circulating mutations.

Dr. Miller comment: We believe that this vaccine provides a benefit and we recommend it.  See below for more information. 

If the infection is mild in children, why not let them get the infection instead?

In many cases, infection is inevitable.  At the present time, the average person will be infected every 9 months.  Even if you had an infection, the booster vaccine offers more prolonged protection from the mutations that are currently circulating.   It is still better to be exposed to just the surface proteins of the virus (through the vaccine), then to get the entire virus.

What is in it for your child?

Your child will get immediate protection and greatly decrease the chance of getting an infection.  For most children, this will provide more prolonged protection until a significant mutation(s) has occurred.   As noted above, it greatly reduces the chance of MIS-C.  As of November 28, 2022; 9,139 children have had MIS-C in the United States, and New York is one of the four states with the highest number of cases.

What is in it for my family?

In addition to reducing risk for your child, reducing infection reduces spreading to a family member who is at higher risk.  It will also reduce exposure to family members without known risk.

What is in it for society?

Mutations are a mistake that occurs when the virus inserts itself into our cells.  Our cells become virus maker machines and make millions of copies of the virus.  When a mistake occurs in the copies, we get mutations.  The number of copies is inversely proportional to the number of infections (i.e. the more the infections, the more the mutations).   If we are to live with this virus and how contagious it is, and we want to do more together with school, families and friends, we need a strategy to minimize the number of infections recognizing that we will not eliminate infections.   Simply put, vaccinations reduce infections which reduce mutations.  They are not perfect, but provide a much better alternative than getting the virus.   

Sick Visits Update

We have had a slight decline in sick visits over the course of the Holiday week.  You may not be feeling it yet, but this is a welcome sign.  We do anticipate some increase in illness from family gatherings and as schools begin again.  Nationally, flu cases are declining, as are RSV cases.  It has been a difficult flu season so far and it has claimed 47 children thus far in the US.  If this year follows previous years, most all children are not vaccinated.  Vaccination remains your best defense for the flu and it is not too late to get one for you or your child.  The current vaccine matches the two Flu A strains that have been circulating.  If there is a second wave of Influenza A or a new wave of Influenza B, it remains to be seen.  

This week the primary virus we feel we are seeing is Adenovirus, and the CDC is seeing this nationally.  Like RSV and many viruses there is no treatment for this virus and it needs to run its course.  Adenovirus will cause conjunctivitis (pink eye), runny nose, cough, sore throat with white spots on the tonsils and sometimes diarrhea,  It is most common in children under 5.  We are also seeing more Strep Throat, but you do not need to be concerned about a sore throat that also presents with cough, runny nose or hoarseness as strep will not cause these symptoms.  Adenovirus can last a few days up to a few weeks.    It is very contagious and can be spread through the eye discharge, runny nose and coughing.  There are no specific treatments, it is all about comfort care, fluids and humidification for comfort.  During the acetaminophen (tylenol) shortage, we are seeing more upset stomachs from higher use of ibuprofen. 

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