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AAP leaders urge vaccination against COVID despite waning effectiveness; provide advice on masking

March 2, 2022

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AAP leaders are stressing the importance of vaccinating children against COVID-19 to protect them from severe disease, even as new studies show waning effectiveness against mild infection with the omicron variant.

“They’re safe and will provide some protection,” Yvonne A. Maldonado, M.D., FAAP, chair of the AAP Committee on Infectious Diseases, said of vaccines. “But we may need to provide additional doses or different levels of dosing in future vaccine formulations and … kids may need to be more protected with masking in schools, etc.”

The AAP also is providing new advice to help families decide whether to continue masking after the Centers for Disease Control and Prevention (CDC) loosened its guidance last week. In addition, the White House rolled out a new plan Wednesday to continue to protect people against COVID, prepare for new variants, prevent economic and school shutdowns, and help vaccinate the world.

Vaccine effectiveness

Data from New York that has not been peer reviewed found waning protection from the Pfizer-BioNTech vaccine against infection among children ages 5-11 years during the omicron period, dropping from 68% in mid-December 2021 to 12% in late January.

Protection against hospitalization went from 100% (95% confidence interval -189% to 100%) to 48% (95% confidence interval -12% to 75%) during that time, although wide confidence intervals limit interpretation of the results.

Protection also fell for adolescents but not as steeply as it did for younger children, according to the study. Adolescents ages 12 years and older receive higher vaccine doses than those under 12 years.

Authors concluded vaccination still should be recommended to prevent severe disease. They stressed the importance of layered protection including masks and suggested looking at alternative vaccine dosing.

In another study that was published in the CDC’s Morbidity and Mortality Weekly Report, researchers examined data from 10 states. For children ages 5-11, it found vaccine effectiveness of 51% against emergency department (ED) and urgent care (UC) visits in the omicron period and 74% (95% confidence interval -35% to 95%) against hospitalization in the combined delta and omicron periods. The wide confidence interval again makes interpretation difficult.

Among adolescents ages 12-15 and 16-17 years during the omicron period, effectiveness rates against ED/UC visits after two doses were 45% and 34%, respectively. In the combined delta and omicron periods, effectiveness of two doses against hospitalization was 92% for ages 12-15 years and 94% for ages 16-17 years.

Effectiveness was lower during the omicron period than during delta and lower 150 or more days after vaccination than earlier in the vaccination period. Authors found a booster shot significantly increased protection among those ages 16-17 years, and they called for all eligible children to be vaccinated and boosted.

Both studies have limitations to their data and Dr. Maldonado said more studies are needed.

Mask guidance

The data on vaccines come as the CDC loosened its guidance on masking and other mitigation measures, saying many people in communities categorized as having a low or medium community COVID level (based on cases and hospital capacity) do not need to mask in indoor public settings. Everyone in high COVID level areas should continue wearing masks.

AAP President Moira A. Szilagyi, M.D., Ph.D., FAAP, called the CDC’s approach reasonable, but said masking continues to be important for children with special health care needs and those too young to be vaccinated.

“We encourage each family to make a plan that works best for them, while also modeling empathy and discouraging bullying of any child who chooses to mask to protect themselves and their family even when not required to do so,” Dr. Szilagyi said in a statement.

When deciding on masking, the AAP recommends families consider

  • whether their child is vaccinated,
  • whether their child is immunocompromised or at high risk for severe COVID-19,
  • whether family members are unvaccinated or at high risk for severe disease and
  • whether they live in a community with a high level of COVID-19.

Based on these factors, families may choose to continue wearing masks in indoor public places even if they are not required, and that decision should be supported. Schools also should have the flexibility to reinstate masking as needed.

Layers of protection have helped keep virus transmission in schools low, according to Dr. Maldonado. While new CDC data show an estimated 58% of children have been infected with COVID-19, she said households and communities have been the most common sources of these infections, not schools.

“We know that schools are not a major source of transmission when you use mitigation,” she said.

White House COVID plan

The White House released its latest COVID-19 plan on Wednesday to account for the changing dynamics of the pandemic. Its initiatives include:

  • ensuring vaccines are widely available for children under 5 years once a vaccine is authorized;
  • making more vaccines, tests and treatments available to all;
  • accelerating efforts to detect, prevent and treat long COVID;
  • allowing people to get tested and treated in one visit at pharmacy-based clinics and other locations;
  • improving data collection on new variants;
  • expediting the process of creating variant-specific vaccines and therapeutics;
  • helping schools and businesses secure testing and improve ventilation to avoid shutdowns;
  • working with businesses to offer paid sick leave for COVID; and
  • delivering 1.2 billion vaccine doses to the world.

Congress would need to approve funding for many of the provisions in the plan.




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