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Black mom, daughter talk with doctor

Wait and see how omicron acts in the real world, says AAP town hall expert

December 7, 2021

Editor’s note: For the latest news on COVID-19, visit http://bit.ly/AAPNewsCOVID19.

Potential risks of the omicron variant and how to talk with families about measures to reduce their risk of COVID-19 were among the topics raised with experts at an AAP virtual town hall.

The meeting on Dec. 2 was on the same day a case of the variant was detected in Minnesota, where panelist Ruth Lynfield, M.D., FAAP, is state epidemiologist and medical director of the Minnesota Department of Health. Dr. Lynfield said the department is working with colleagues in New York City, where the Minnesota patient recently attended a large convention.

Watch and wait

The emergence of omicron has led to concerns that it has more than 30 mutations, some of which have been associated with increased transmissibility, said Dr. Lynfield, associate editor of the AAP Red Book.

“But what’s really important for people to know is that we need to see how it works in the real world and what these changes in the virus mean,” she said. “…We do have some sense that perhaps it is more infectious, but we need to see how that pans out.”

Efforts are underway to determine whether certain monoclonal antibodies are effective against the variant, and more information is expected in the coming weeks, she added.

Another panelist, José R. Romero, M.D., FAAP, a member of the AAP Committee on Infectious Diseases, explained why the World Health Organization classified omicron as a variant of concern after it was first identified in South Africa.

“We know there seems to be rapid transmission of this in South Africa. We’ll wait and see where it is in other parts of the world. Remember that South Africa also didn’t have a higher rate of immunization among the general population,” said Dr. Romero, immediate past chair of the Advisory Committee for Immunization Practices of the Centers for Disease Control and Prevention (CDC) and professor of pediatrics and pediatric infectious diseases at University of Arkansas for Medical Sciences.

Dr. Romero, who also is director of the Arkansas Department of Health, added that his state is obtaining sequencing on as many specimens as possible. He is interested in what changes occur in cases — whether they are all delta or other variants such as omicron and whether there is a recombination.

“I suspect that if it (recombination) occurs with poliovirus, which is a prototypical RNA virus, it can occur with coronavirus, so I think that that may have some play with this,” he said.

Talking with families

Meanwhile, families continue to have questions about the best way to protect themselves.

Amy Houtrow, M.D., M.P.H., FAAP, who treats children with disabilities, said her guidance is similar to recommendations about the delta variant: Anyone who is eligible to be vaccinated should be vaccinated and take additional steps that help prevent the spread of infection.

“It’s even more important right now, especially in places where there’s a high rate of infection,” said Dr. Houtrow, chief of the Division of Pediatric Rehabilitation Medicine, vice chair for quality and safety at UPMC Children’s Hospital of Pittsburgh and a member of the AAP Section on Home Care Executive Committee.

“I know that’s been exceptionally hard for families given the nature of parents having to manage their own work and their kids’ schooling, and this has been especially hard for families of children with disabilities,” Dr. Houtrow said.

Parents probably are expressing more hesitancy about the vaccine for younger children than adolescents, Dr. Houtrow said. As a pediatric subspecialist, she said she is fortunate to “piggyback on all the great work that the general pediatricians are doing in primary care, where they’re really encouraging vaccinations.”

She also has the luxury of spending extra time with families to address concerns and disinformation.

“It feels like a great success when you get someone over the hump of their hesitancy to accept vaccination. …I’ve had many families come back and say how grateful they were that I was willing to do that because … they just needed that extra support,” she said.

Dr. Romero said he reminds families with children too young to get vaccinated that they can reduce their risk by cocooning — having other individuals in the household immunized.

Parents also bring up questions about myocarditis. While myocarditis is a rare occurrence and generally benign, Dr. Romero said, pediatricians can consult with experts at the CDC’s Clinical Immunization Safety Assessment Project as well as a local cardiologist.

He said it's important for pediatricians to inform parents that the CDC's Vaccine Safety Technical Work Group looks at vaccine safety data weekly.

Still another town hall topic concerned lingering COVID-19 symptoms that affect some children. Experts said families can be referred to a pediatric “long COVID” clinic, pediatric rehabilitation medicine clinic or setting offering multidisciplinary, team-based care.

Resource

The next AAP COVID-19 town hall will be held at 7 p.m. CT on Dec. 16. To register, visit http://bit.ly/covid19townhallseries.

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