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U.S. Surgeon General Vivek H. Murthy, M.D., M.B.A., responded to pediatricians’ questions about myocarditis and mRNA vaccines and discussed pediatricians’ role in supporting vaccine confidence at an interactive virtual COVID-19 town hall hosted by the AAP and Children’s Hospital Association Thursday.
Top of mind was news about cases of myocarditis in young people after COVID-19 mRNA (Pfizer-BioNTech and Moderna) vaccination. Members of the Food and Drug Administration’s (FDA’s) Vaccines and Related Biological Products Advisory Committee met virtually Thursday to discuss 226 cases of myocarditis or pericarditis reported in people ages 30 and younger since April 2021 and 250 more still under investigation.
Dr. Murthy said most of the cases reported to the Vaccine Adverse Event Reporting System have been mild.
“They have occurred predominantly in male adolescents and young adults up to their early 20s. … Most often, it has happened after the second dose of the vaccine and typically within several days after that second dose,” he said. Most patients have recovered with supportive care.
The overall number of cases is small compared to the millions of doses administered to adolescents, he said. “(But) anything regarding the health of children — or anyone for that matter — we want to take absolutely seriously.”
The Centers for Disease Control and Prevention (CDC) and FDA are continuing to evaluate reports to determine whether they are related to the vaccine or other causes. The CDC’s Advisory Committee on Immunization Practices will hold an emergency meeting on June 18 to discuss myocarditis cases.
“The bottom line is this: When you compare the risk of cardiac complications among adolescents who have had COVID vs. the numbers that we're seeing here, it is very clear to us at this point in time that the benefits still outweigh the risk when it comes to vaccination,” he said.
Small practices, large quantities of vaccine
With many physicians’ offices awaiting COVID-19 vaccines, pediatricians in small practices may have concerns about managing a large quantity of vaccine doses.
Dr. Murthy said funding through the American Rescue Plan is intended to support states in managing and breaking up large quantities of doses so that physicians’ offices and other smaller locations can participate in COVID-19 vaccine rollout efforts.
He also suggested that pediatricians connect with nearby practices to break up and share the vaccine supply. But even with the best efforts, pediatricians should expect some doses will go to waste.
“I just want to say that out loud, because even if you waste some vaccine but if you're able to vaccinate other children, we want that to happen,” he said. “Of course, our mind always goes to those who may be looking for a vaccine and can't get it, whether it's in the United States or other parts of the world … We'd rather have some wastage but get people vaccinated than not have vials opened, and ultimately, we will be worse off in that case.”
Questions asked, answered
Pediatricians had an opportunity to chat with Dr. Murthy, ask questions and share personal stories. Among topics discussed:
- What pediatricians can do to make equity central and in turn, vaccinate more youths.
- How to work with schools to extend vaccination to more families.
- How to address COVID-19 myths that the vaccine is linked to infertility or changes a person’s DNA.
- How to prioritize mental health for patients and pediatricians.
Finally, Dr. Murthy urged pediatricians to continue addressing vaccine hesitancy in their communities. With new information about COVID-19 vaccines spreading as rapidly as misinformation, he said, one-on-one conversations can make a difference even when the person does not follow the pediatrician’s advice after the first conversation.
“The most powerful and important messengers in this effort to protect our country, our patients and our communities are you. … When people have a chance to talk to you, their doctors, whether they’re your patients themselves or their parents, it can make a huge difference,” he said. “You have the information. You have the relationships, which give you the trust. That’s why you have the power to help more people get vaccinated.”
CDC guidance for clinicians on myocarditis/pericarditis after COVID-19 vaccination, https://bit.ly/3zi8ngb